SURGERY SURGICAL CLAMP APPLICATOR INSTRUMENTS WITH JOINT JAWS

Abstract

A surgical instrument for applying surgical staples to tissue comprises an end effector with a first and a second jaw that are movable between an open and a closed position. The instrument includes a drive element configured to move distally from the shaft into the end effector to deliver one or more staples to the first and second jaws. The instrument further includes at least one actuating rod extending through the shaft laterally to the drive element relative to the longitudinal axis and configured to move the jaws between the open and closed positions. Positioning the jaw actuator laterally to the drive element creates space for the drive element to deliver multiple staples to the jaws without interfering with the opening and closing of the jaws.

Description

REFERENCE TO RELATED REGISTRATIONS

[0001] The present application claims the advantage of the following provisional U.S. applications: (1) Serial No. 63 / 505,738, filed on June 2, 2023; (2) Serial No. 63 / 505,740, filed on June 2, 2023; (3) Serial No. 63 / 505,742, filed on June 2, 2023; (4) Serial No. 63 / 505,870, filed on June 2, 2023; (5) Serial No. 63 / 505,875, filed on June 2, 2023; and (6) Serial No. 63 / 505,735, filed on June 2, 2023, the full disclosures of which are hereby incorporated by reference for all purposes. BACKGROUND

[0002] The present description concerns endoscopic surgical instruments in general for dissecting, closing and / or sealing tissue, and in particular endoscopic surgical instruments with which multiple clamps can be applied to vessels and / or tissue.

[0003] Minimally invasive medical techniques aim to reduce the amount of foreign tissue damaged during diagnostic or surgical procedures, thereby shortening patient recovery time, discomfort, and adverse side effects. One effect of minimally invasive surgery, for example, is a reduction in postoperative hospital recovery time. The average hospital stay for standard open surgery is typically significantly longer than the average stay for a comparable minimally invasive procedure (MIS). Therefore, increased use of MIS could save millions of dollars in hospital costs each year.Although many of the surgeries performed annually in the United States could potentially be performed minimally invasively, these advantageous techniques are only used in a portion of current surgeries due to the limitations of minimally invasive surgical instruments and the additional surgical training required to master them.

[0004] Improved surgical instruments, such as those for accessing, navigating, dissecting, and sealing tissue, have allowed minimally invasive surgery (MIS) to redefine the field of surgery. These instruments enable surgical and diagnostic procedures to be performed with less trauma to the patient. A common form of minimally invasive surgery is endoscopy, and a common form of endoscopy is laparoscopy, which is a minimally invasive examination and surgery performed within the abdominal cavity. In standard laparoscopy, the patient's abdominal cavity is insufflated with gas, and cannula sheaths are inserted through small incisions (about half an inch or less) to create access ports for laparoscopic instruments.

[0005] Laparoscopic surgical instruments generally include an endoscope (e.g., a laparoscope) for viewing the surgical field and tools for working at the surgical site. The working tools are usually similar to those used in conventional (open) surgery, except that the working end, or end effector, of each tool is separated from the handle by an extension tube (also known, for example, as an instrument shaft or main shaft). The end effector might include, for example, a clamp, grasping forceps, scissors, a stapler, a cautery tool, a linear cutter, or a needle holder.

[0006] To perform surgical procedures, the surgeon guides the instruments through cannula sleeves to an internal surgical site and operates them from outside the abdomen. The surgeon monitors the procedure on a screen displaying an image of the surgical site captured by the endoscope. Similar endoscopic techniques are used, for example, in arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like.

[0007] Minimally invasive telemedicine robotic systems are being developed to enhance the surgeon's dexterity when working at an internal surgical site and to allow the surgeon to operate on a patient from a remote location (outside the sterile field). In a telemedicine system, the surgeon is often shown an image of the surgical site on a control console. While viewing a three-dimensional image of the surgical site on a suitable screen or display, the surgeon performs the surgical procedures on the patient by operating master input or control devices on the control console, which in turn control the movement of servomechanically driven slave instruments.

[0008] The servomechanism used for telesurgery often accepts input from two master controllers (one for each of the surgeon's hands) and may include two or more robotic arms, each carrying a surgical instrument. Operational communication between the master controllers and the associated robotic arm and instrument assemblies is typically achieved through a control system. This control system typically includes at least one processor that relays input commands from the master controllers to the associated robotic arm and instrument assemblies, and, in the case of force feedback or similar features, from the instrument and arm assemblies back to the associated master controllers. An example of a robot-assisted surgical system is the DA VINCI™ system, marketed by Intuitive Surgical, Inc. of Sunnyvale, California.

[0009] A number of different structural arrangements have been used to support the surgical instrument at the surgical site during robot-assisted surgery. The powered linkage, or “slave,” is often referred to as the robot-assisted surgical manipulator, and exemplary linkage assemblies for use as a robot-assisted surgical manipulator in minimally invasive robot-assisted surgery are described in U.S. Patents Nos. 7,594,912 (filed September 30, 2004), 6,758,843 (filed April 26, 2002), 6,246,200 (filed August 3, 1999), and 5,800,423 (filed July 20, 1995), the complete disclosures of which are incorporated herein by reference in their entirety for all purposes. These linkages often manipulate an instrument holder to which an instrument with a shaft is mounted.Such a manipulator structure can include a parallelogram linkage section that generates movement of the instrument holder limited to rotation about a pitch axis intersecting a remote manipulation center located along the length of the instrument shaft. Alternatively, such a manipulator structure can include a yaw joint that generates movement of the instrument holder limited to rotation about a yaw axis perpendicular to the pitch axis, also intersecting the remote manipulation center. By aligning the remote manipulation center with the incision point toward the internal surgical site (e.g., with a trocar or cannula against the abdominal wall during laparoscopic surgery), the end effector of the surgical instrument can be safely positioned by moving the proximal end of the shaft via the manipulator linkage without exerting potentially dangerous forces on the abdominal wall.Alternative manipulator structures are described, for example, in US patents Nos. 6,702,805 (filed November 9, 2000), 6,676,669 (filed January 16, 2002), 5,855,583 (filed November 22, 1996), 5,808,665 (filed September 9, 1996), 5,445,166 (filed April 6, 1994), and 5,184,601 (filed August 5, 1991), the complete disclosures of which are hereby incorporated by reference in their entirety for all purposes.

[0010] During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools with end effectors that perform various functions for the surgeon, such as holding or driving a needle, grasping a blood vessel, dissecting tissue, or the like, in response to manipulation of the master input devices. Manipulation and control of these end effectors is a particularly advantageous aspect of robot-assisted surgical systems. Such mechanisms should be appropriately sized for use in minimally invasive procedures and relatively simple in design to reduce potential sources of error. Furthermore, these mechanisms should offer a sufficient range of motion to allow the end effector to be manipulated in a variety of positions.

[0011] Endoscopic surgical clips are used in a variety of minimally invasive or endoscopic surgical procedures to close, ligate, and / or seal vessels and tissues. Applying surgical clips typically involves compressing the clip over the surgical site, such as a blood vessel. Once the compressed surgical clip is in place on the vessel, it interrupts the flow of fluid through it.

[0012] Conventional surgical clamps are designed to be compressed around a grasped vessel or other tissue into a latched or locked position. Typically, the surgical instrument includes jaws that can be closed to engage projections formed on the clamps. These projections are pressed inward around a hinged section, closing the first and second arms of the applied clamp around the grasped vessel. The pointed end of the second arm then begins to contact a hook. After the jaws are opened, the pointed end snaps into the locking recess and fits snugly, securing the clamp in a latched position.

[0013] Certain endoscopic surgical staple applicators comprise a surgical instrument with a movable-jaw end effector and a single staple installed within the end effector. These instruments are limited to a single discharge per instrument. In other words, after dispensing a staple and applying it to tissue, the surgeon must remove the surgical instrument from the cannula and manually insert a new staple into the instrument or use a completely different surgical staple applicator (i.e., a new instrument).

[0014] Other laparoscopic staple applicators have been developed with a magazine that can be preloaded with approximately 2 to 10 staples. However, these staple applicators are generally single-use and designed to be disposed of after a procedure. Some existing endoscopic surgical staple applicators are "straight" or "non-articulated" instruments, in which the user cannot change the orientation of the jaws relative to the shaft of the instrument during or after advancing the staple.

[0015] Furthermore, over time, the staples in the staple magazine typically assume a "fixed" closed position (i.e., the staple legs tend to approach each other and assume a closed or semi-closed position while stored in the magazine). Unfortunately, these "multi-fire" staple applicators are unable to securely retain the staple prongs in the jaws after they have been advanced. In such a case, the staple applicator may fail and drop a staple into the surgical field.

[0016] Although the new telemedicine systems and devices have proven highly effective and beneficial, further improvements would still be desirable. In general, it would be advantageous to provide improved endoscopic staple applicators capable of delivering multiple staples without requiring instrument changes or jaw repositioning. Furthermore, it would be beneficial to provide such improved endoscopic staple applicators without compromising the overall size of the instrument, thus enabling the design of more compact and maneuverable instruments. SUMMARY

[0017] The following is a simplified summary of the claimed subject matter, intended to provide a basic understanding of some aspects of the claimed subject matter. This summary is not a comprehensive overview of the claimed subject matter. It is not intended to identify essential or critical elements of the claimed subject matter, nor to define its scope. Its sole purpose is to present some concepts of the claimed subject matter in simplified form as an introduction to the more detailed description presented later.

[0018] In one aspect, a surgical instrument for applying surgical staples to tissue comprises an elongated shaft with a longitudinal axis and an end effector coupled to the shaft, which includes a first and a second jaw that are movable between an open and a closed position. The instrument includes a drive element configured for distal displacement from the shaft into the end effector to deliver one or more staples to the first and second jaws, and an actuator extending through the shaft to move the jaws between the open and closed positions. The actuator is positioned laterally to the drive element relative to the longitudinal axis to allow clearance for the passage of the drive element and the staples from the shaft to the end effector.

[0019] The actuator may include a cable drive or similar actuating mechanism that opens and closes the jaws by longitudinally sliding the cable drive (i.e., a push / pull mechanism). In one embodiment, the cable drive comprises an elongated rod with a distal end section. A slotted pin is coupled to the distal end section. The end effector and / or one of the jaws includes a slot, and the cable drive slides the pin through the slot to move the jaws between the open and closed positions. In certain embodiments, the cable drive may be coupled to a first and second slotted pin configured to slide through a first and second slot in the jaws. The sliding of the slotted pins through the slots opens and closes the jaws.

[0020] In embodiments, the instrument further comprises a wrist assembly that rotatably couples the end effector to the shaft, and an inner tube extending through the wrist assembly. At least a portion of the drive element is configured to move through the inner tube, and the cable drive is positioned laterally to the inner tube.

[0021] In some embodiments, the instrument comprises a first and a second cable drive extending laterally through the shaft to the drive element. The first and second cable drives can, for example, each be positioned on one side of the shaft to allow the drive element to pass through it. In these embodiments, each of the cable drives is coupled to one or more slotted pins in the end effector to open and close the jaws by compressing or tensioning the cable drives.

[0022] In embodiments, the cable drive(s) comprise a handle cable with a flexible section extending through the inner tube in the wrist assembly and a first and a second substantially rigid section on either side of the flexible section. The rigid sections allow tension and compression of the handle cable to open and close the jaws. The flexible section is configured to compensate for changes in the length and / or angle of the wrist assembly. This allows, for example, a surgeon to apply one or more surgical staples to tissue or vessels without having to change the orientation of the jaws while advancing the staples, thus reducing interruption to the surgeon's workflow.By providing at least one degree of rotational movement relative to the shaft, the end effector can correspond to at least part of the natural movement of a surgeon's wrist, thereby facilitating the placement of the jaws in the optimal position for performing the sealing / closing function, particularly in a laparoscopic procedure where the instrument has been inserted into the abdominal cavity through a small entry point.

[0023] In such an embodiment, the handle cable(s) comprise an outer sheath that is attached to a first section of the wrist assembly and slidably coupled to a second section of the wrist assembly. The outer sheath has a flexible section to prevent the handle cable from kinking when the handle cable is under pressure (i.e., pressed distally to open or close the jaws).

[0024] In certain embodiments, the handle cable(s) may include a first layer of flexible tubing between the outer sheath and the handle cable, configured to contain the cable strands under compression. The handle cable may include a second layer of flexible tubing positioned over the first layer. This second layer of tubing overlaps the rigid and flexible sections of the handle cable to ensure a continuous outer diameter.

[0025] The wrist assembly can, for example, comprise first, second, and / or third linkages or discs to rotatably couple the end effector to the shaft. The outer sheath of the handle cable is preferably attached to the distal linkage or disc and slidably coupled to the proximal linkage(s) or disc(s).

[0026] In such an embodiment, the wrist assembly comprises a first and a second linkage or disc for jointing the end effector about a first and second axis, respectively. The first and second axes can be, for example, yaw and pitch axes. The inner tube extends through the entire wrist assembly, allowing a user to apply surgical clamps to tissue or vessels via the wrist element, thus enabling the end effector to be rotated about at least two axes relative to the shaft. This further enhances the surgeon's ability to reposition the jaws relative to the target vessel or tissue.

[0027] In embodiments, the drive element comprises a distal section configured for releasable engagement with a clamp and a flexible section extending through the wrist element when the distal section is located within the end effector. The drive element further comprises a proximal section extending through the shaft and configured for coupling to an actuator, such as an instrument handle or an external control system. The flexible section allows the distal section to pivot relative to the proximal section as the end effector pivots around the wrist element.

[0028] In some embodiments, the first and second jaws each comprise a guide rail extending from the wrist element to a distal end of the jaws. The guide rails facilitate the advancement of the clamp and the engagement elements of the drive element through the jaws and into position, enabling the jaws to open and / or close the clamp.

[0029] In another aspect, a surgical instrument for applying surgical staples to tissue comprises an elongated shaft, a wrist assembly, and an end effector rotatably coupled to the shaft around the wrist assembly. The end effector includes a first and a second jaw, which are movable between an open and a closed position. The instrument further comprises a flexible tube with an internal channel extending through the wrist assembly and a drive element configured for longitudinal movement through the internal channel of the flexible tube to deliver one or more surgical staples to the first and second jaws.

[0030] In some embodiments, the flexible hose is configured to bend as the wrist assembly moves in a pivot-like manner relative to the end effector. This provides a flexible, smooth channel for the passage of the drive element and clamps, even when the wrist assembly moves in such a pivot-like manner that the end effector and shaft are not oriented parallel.

[0031] In certain embodiments, the wrist assembly is pivotably coupled to the end effector about a first and a second axis, the first and second axes being perpendicular to the shaft axis. The flexible hose is configured to bend at least one first and a second point along the flexible hose as the wrist assembly rotates about the first and second axes. In a preferred embodiment, the flexible hose comprises a spool with an elastic polymer sheath or casing surrounding the spool. The spool provides a structure that prevents kinking as the wrist assembly rotates and creates tight bends in the flexible hose. The polymer casing surrounds and is bonded to the spool, thus creating a flexible structure for the spool.

[0032] In one embodiment, the flexible hose comprises a cross-section with a semicircular section and a substantially linear section, resulting in a substantially D-shaped cross-section. This cross-section allows the cable drive to extend laterally outward from the flexible hose along the linear section, thereby creating space within the wrist assembly for the passage of the drive element and the clamps.

[0033] In another embodiment, the flexible hose has a cross-section with a first and second substantially linear section and a first and second semicircular section extending between the linear sections. This cross-section allows a first and second cable drive to extend along the linear sections of the hose.

[0034] In another aspect, a surgical instrument for applying surgical staples to tissue comprises an elongated shaft and an end effector coupled to the shaft, which includes a first and second jaw that are movable between an open and a closed position. The instrument includes a wrist assembly and a drive element configured for longitudinal movement through the wrist assembly to deliver one or more surgical staples to the first and second jaws. The wrist assembly includes one or more connecting links that rotatably connect the end effector to the shaft about an axis perpendicular to the shaft.

[0035] In some embodiments, the wrist assembly comprises a proximal connecting element and a distal connecting element. The distal connecting element can be attached to the end effector in such a way that rotation or joint movement occurs only between the proximal and distal connecting elements of the wrist assembly. This configuration "decouples" the jaws from the wrist assembly, giving the surgeon greater control and precision in positioning the jaws in the correct orientation for applying a clamp to tissue or a vessel.

[0036] In embodiments, the wrist assembly further comprises a central connecting link between the proximal and distal connecting links. The central connecting link is rotatably connected to the proximal connecting link about a first axis and to the distal connecting link about a second axis. This configuration allows both yaw and pitch joint movement of the end effector relative to the shaft.

[0037] In some embodiments, the instrument includes a staple magazine within the shaft and comprises at least one first and one second staple, generally spaced apart from each other along the longitudinal axis of the shaft. A drive element is configured to advance the first staple into the end effector, retract it from the end effector, and advance the second staple into the end effector. This allows multiple staples to be applied to target sites within a patient without the need to change instruments or the staple magazine.

[0038] In various embodiments, the drive element comprises at least one engagement element for releasably coupling it to the first and second clamps. In one embodiment, the drive element is arranged within the clamp magazine, which may, for example, be disposable. In another embodiment, the drive element is movably coupled to the shaft, which may, for example, be reusable.

[0039] In embodiments, the jaws each have an engagement feature at their distal ends to secure the staples after they have been fed by the drive element. The engagement features allow the drive element to be released from the staple after the staple has been attached to the jaws. Thus, the force required to release the drive element from the staple is less than the force required to release the staple from the engagement features. Furthermore, these engagement features ensure that the staple does not fall out of the jaws before they are closed and stapled to tissue or a vessel at the target site. In a preferred embodiment, these engagement features comprise ramped leaf springs configured to secure each of the two arms of the staple to the first and second jaws, respectively.

[0040] In some embodiments, the drive element is configured to remain coupled to the surgical clamp as the first and second jaws move between the open and closed positions. The drive element holds and controls the clamp, allowing it to position the clamp arms within the jaws of the end effector and retain the clamp while the end effector is opened and closed and / or moved joint-like relative to the instrument shaft. This allows the surgeon to fully open the clamps after they have been advanced into the jaws, enabling effective positioning around a target vessel or tissue. Furthermore, the surgeon can reposition the jaws relative to the shaft after advancing the clamp into the jaws.

[0041] In one embodiment, the engagement elements of the drive element are configured for detachable coupling with each of the two arms of the clamp to allow additional control of the clamp within the jaws of the instrument. The clamp comprises a first and a second arm, which are pivotably coupled to each other about a hinge and are movable relative to each other between an open and a closed position. The clamp further comprises a first and a second engagement element on the first and second arms, respectively. These engagement elements are configured for detachable coupling with the first and second engagement elements of the drive element. The engagement elements are preferably located near or at the distal end sections of each of the arms (or the ends opposite the hinge).

[0042] In another embodiment, the engagement elements of the drive element are configured for detachable coupling with a proximal section of the clamp. The engagement elements can, for example, comprise first and second tabs that are pre-tensioned inwards for attachment to the hinge section of the clamp.

[0043] In some embodiments, the first and second jaws each include a guide rail. The first and second engagement elements are configured to advance along the guide rails as the drive element is advanced distally into the jaws. This ensures that the first and second arms of the clamp are optimally positioned on one of the jaws, even when the jaws are open and / or when the jaws are articulated relative to the shaft as the clamp is advanced.

[0044] In certain embodiments, the drive element is coupled to an actuator configured to move the drive element in proximal and distal directions. The actuator may, for example, include a handle of the surgical instrument, allowing the surgeon to manually advance and retract the drive element and / or open and close the jaws of the instrument.

[0045] In embodiments, the actuator is configured to couple with a robot-assisted telemanipulated control system. The robot-assisted telemanipulated control system may include a control system coupled to the actuator and configured to move the drive element proximal and distally relative to the end effector. Additionally, the control system may include one or more actuators for opening and closing the jaws. In one configuration, for example, the actuator is manipulated by the robot-assisted manipulator assembly to move the jaws of the end effector between an open position and a closed position. In the closed position, the jaws are actuated into compressive contact with the legs of a clamp, thereby compressing the clamp into a clamped or locked position around a vessel or other tissue.

[0046] In embodiments, the control system can monitor and control the longitudinal position of the drive element relative to each of the clamps within the magazine. In particular, the control system can monitor the position of the engagement elements along the magazine to determine when the drive element should be moved distally or proximally.

[0047] It should be understood that both the preceding general description and the following detailed description are merely exemplary and illustrative, and do not limit the scope of the description. Additional features are partly explained in the following description or can be learned through practical application. BRIEF DESCRIPTION OF THE DRAWINGS

[0048] The aforementioned aspects, features, and advantages of the surgical instruments presented here, as well as others, will become clearer through the following detailed description in conjunction with the accompanying drawings. This will show: Fig. 1. A perspective view of a distal section of a surgical instrument; Fig. 2 an exploded view of the surgical instrument made of Fig. 1 with a clip magazine configured for insertion through a longitudinal slot on the side of the instrument shaft; Fig. 3A and Fig. 3B a surgical instrument with a clip magazine configured for insertion through a proximal end of the instrument; Fig. 4 a partial cross-sectional view of the surgical instrument made of Fig. 1; Fig. 5 an enlarged view of a section of a clamp magazine and a drive element of the surgical instrument; Fig. 6A the drive element of the surgical instrument; Fig. 6B distal engagement elements of the drive element; Fig. 7A-7E alternative embodiments of drive elements for the surgical instrument; Fig. 8A a bracket in the open position; Fig. 8B a bracket in the closed position; Fig. 8C a top view of one arm of a clamp; Fig. 8D a side view of the bracket in a partially closed position; Fig. 9A a side view of a distal hook on one arm of the clamp; Fig. 9B a front view of a distal locking mechanism on another arm of the clamp; Fig. 9C a front view of the distal hook; Fig. 9D a rear view of the distal locking mechanism; Fig. 9E a close-up of the hook and locking mechanism in a closed position; Fig. 10A the first and second jaw of the instrument Fig. 1, wherein a clamp is attached to the drive element inside the jaws; Fig. 10B the jaws in an open position; Fig. 10C the jaws in a closed position; Fig. 10D a top view of one of the jaws, illustrating the four-bar linkage of the jaws; Fig. 10E a cross-sectional view of one of the jaws illustrating ramp-shaped leaf springs at the distal ends of the jaw; Fig. 11A a cross-sectional view of the first and second jaws, which are connected in a yaw direction relative to the shaft in a hinge-like manner; Fig. 11B a cross-sectional view of the end effector of the instrument, showing the drive element and clamp which is advanced through a wrist assembly and into the jaws of the instrument; Fig. 12A a cross-sectional view of part of the surgical instrument illustrating the clamp magazine and drive element; Fig. 12B a close-up of the staple magazine and drive element showing the distal engagement elements of the drive element in a distal position relative to the upper and lower ramps on the staple magazine; Fig. 13A and Fig. 13B the distal engagement elements of the drive element after proximal retraction into a proximal position relative to a distal set of upper and lower ramps on the clamp magazine; Fig. 14A and Fig. 14B the distal engagement elements of the drive element that pass through openings in the outer surface of the clamp magazine; Fig. 15A-15C the distal engagement elements of the drive element which engage with engagement features on the first or most distal staple in the staple magazine; Fig. 16A and Fig. 16B the drive element that advances the first clamp through a wrist of the surgical instrument and into the jaws; Fig. 17 the clamp and the drive element, which engage with the first and second jaws, with the jaws in the open position; Fig. 18 the first and second jaw in a joint position around the wrist relative to the shaft; Fig. 19A the clamp and the drive element, which engage with the first and second jaws, with the jaws in the closed position; Fig. 19B a close-up of the locking mechanism of the clamp and the drive element engaging with one of the jaws; Fig. 20A the drive element that is retracted from the end effector of the instrument after the clamp has locked; Fig. 20B a close-up of the clamp and jaws in closed position after the clamp has locked; Fig. 21 the drive element is positioned for proximal retraction to engage a second clamp in the clamp magazine; Fig. 22 a perspective view of a distal section of an alternative embodiment of a surgical staple applicator instrument; Fig. 23 the surgical instrument from Fig. 22 with a clip magazine configured for insertion through a longitudinal slot on the side of the instrument shaft; Fig. 24 the surgical instrument from Fig. 22 with a clip magazine configured for insertion through a proximal end of the instrument; Fig. 25 an exploded view of the clamp magazine and the surgical instrument made of Fig. 22; Fig. 26A a cross-sectional view of the surgical instrument made of Fig. 22 with a clip magazine installed therein; Fig. 26B an enlarged view of part of the surgical instrument showing the staple magazine and a drive element, as well as the distal engagement elements of the drive element engaging with engagement elements on the first or most distal staple in the staple magazine; Fig. 26C an enlarged view of the proximal engagement elements of the drive element and a single clamp within a magazine; Fig. 27 a clip magazine designed for insertion into a longitudinal slot or proximal opening of the surgical instrument made of Fig. 22 is configured; Fig. 28 a clamp magazine designed for insertion into a proximal opening of the shaft of the surgical instrument Fig. 22 is configured; Fig. 29A-29C enlarged views of the distal part of the staple magazine and a single staple; Fig. 30 the drive element of the surgical instrument; Fig. 31 a distal part of the drive element from Fig. 30; Fig. 32 a proximal part of the drive element Fig. 30; Fig. 33A-33C alternative embodiments of drive elements for the surgical instrument; Fig. 34 a bracket in a partially open position; Fig. 35A the clamp in a fully open position; Fig. 35B a bracket in the closed position; Fig. 36A and Fig. 36B the drive element coupled to a proximal part of the clamp; Fig. 37A another embodiment of a clamp; Fig. 37B another embodiment of a drive element for use with the clamp made of Fig. 37A; Fig. 38A-38C another embodiment of a clamp and a drive element; Fig. 39A and Fig. 39B another embodiment of a clamp and a drive element; Fig. 40A the first and second jaw of a surgical stapling applicator instrument in an open position; FIG; 40B the first and second jaw in a closed position; Fig. 40C a partial cross-sectional view of the jaws in the open position; Fig. 40D a partial cross-sectional view of the jaws in the closed position; Fig. 41A another embodiment of the first and second jaw in an open position; Fig. 41B the cheeks out Fig. 41A in the closed position; Fig. 42 a wrist assembly and a drive cable for a surgical staple applicator; Fig. 43A a partial cross-sectional view of the wrist assembly and the drive cable from Fig. 42; Fig. 43B a partial cross-sectional view of the wrist assembly and the drive cable, wherein the wrist assembly is connected in a hinge-like manner relative to the shaft of the instrument; Fig. 44A an inner tube within the wrist assembly; Fig. 44B an alternative embodiment of an inner tube for the wrist assembly; Fig. 45A a perspective view of the inner tube from Fig. 44A; Fig. 45B the inner tube within the wrist assembly during the joint-like movement of the wrist assembly; Fig. 46 a perspective view of a drive cable for opening and closing the jaws; Fig. 47A the drive cable with removed parts; Fig. 47B the drive cable with a heat shrink tube over a flexible section of the drive cable; Fig. 47C the drive cable with another layer of heat shrink tubing; Fig. 48A a cross-sectional view of the instrument showing the drive element which advances a clamp through the shaft of the instrument; Fig. 48B an enlarged view of the drive element coupled to the clamp; Fig. 49A a cross-sectional view of the instrument showing how the drive element advances the clamp through the wrist assembly; Fig. 49B an enlarged view of Fig. 49A; Fig. 49C the drive element that advances the clamp through the wrist assembly while the wrist is moved joint-like relative to the shaft; Fig. 49D a partial cross-sectional view of Fig. 49C; Fig. 50A and Fig. 50B the clamp, which is advanced by guide rails in the jaws; Fig. 51 the clamp which is attached to the distal ends of the jaws while the drive element is withdrawn proximally from the jaws; Fig. 52A-52C the jaws in the closed position in which they lock the clamp; Fig. 53 a perspective view of the inner tube in a hinge-like orientation; Fig. 54A-54C a clamp which is advanced through the wrist assembly in an essentially orthogonal orientation relative to the wrist axis; Fig. 55A-55C a clamp which is advanced through the wrist assembly in an essentially 45-degree orientation relative to the wrist axis; Fig. 56 a perspective view of a representative telemanipulated surgical instrument that can be used with an exemplary embodiment of the present teachings; Fig. 57 a top view of an operating room in which a robot-assisted surgical system is used; Fig. 58 a simplified side view of a robot arm assembly; and Fig. 59 a flowchart of a process for operating a surgical staple applicator instrument with a control system. DETAILED DESCRIPTION

[0049] Certain embodiments of the present surgical instruments are described below with reference to the accompanying drawings; however, it should be understood that the disclosed embodiments are merely exemplary and can be implemented in various forms. Therefore, the specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis to convey to those skilled in the art how the devices described herein can be used in various ways in virtually any suitable detailed structure. Known functions or constructions are not described in detail in order to avoid obscuring the present description with unnecessary details. Identical numbers in two or more figures represent identical or similar elements.Furthermore, elements and associated aspects that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and not described with reference to a second embodiment, the element may nevertheless be claimed to be included in the second embodiment. Moreover, the illustrations contained herein are for illustrative purposes only and do not necessarily reflect the actual shape, size, or dimensions of the system or the illustrated components.

[0050] Although the following section presents surgical instruments compatible with surgical staple magazines, it should be understood that certain features of the surgical instruments described herein can be readily adapted for use in any type of surgical clamping, cutting, ligating, dissecting, stapling, cauterizing, suturing, and / or sealing instrument, regardless of whether the surgical instrument uses a staple or another type of fastening element. Furthermore, the features of the surgical ligating instruments described herein can be readily adapted for use in surgical instruments operated by any technique within the practitioner's scope of expertise, such as manually operated surgical instruments, powered surgical instruments (e.g., electromechanically powered instruments), robot-assisted surgical instruments, and the like.

[0051] The devices described herein, or certain components thereof, may also be incorporated into a variety of surgical instruments, such as those described in jointly assigned, co-pending U.S. patent applications Nos. 16 / 205,128, 16 / 427,427, 16 / 678,405, 16 / 904,482, 17 / 081,088 and 17 / 084,981 and international patents Nos. PCT / US2019 / 107646, PCT / US2019 / 019501, PCT / US2019 / 062344, PCT / US2020 / 54568, PCT / US2019 / 064861, PCT / US2019 / 062768, PCT / 2020 / 025655, PCT / US2020 / 056979, PCT / 2019 / 066513, PCT / US2020 / 020672, PCT / US2019 / 066530 and PCT / US2020 / 033481 are described, the complete disclosures of which are incorporated herein by reference in their entirety for all purposes as if they had been copied and pasted herein.

[0052] Fig. Figure 1 shows the distal end section of a surgical instrument 100 according to an illustrative embodiment. The surgical instrument 100 comprises an end effector 110, an elongated shaft 105, and a wrist assembly 140 that couples the end effector 110 to the shaft 105. The proximal end section of the elongated shaft 105 is operatively connected to an actuating mechanism (not shown), although a person skilled in the art reading this description will recognize that components of the actuating mechanism extend into and / or pass through the elongated shaft 105 and / or the wrist assembly 140.

[0053] In certain embodiments, the surgical instruments described herein are designed for use with a robotic system for applying ligature clips. The surgical instruments generally include an actuating mechanism that controls the orientation and movement of the end effector. The actuating mechanism is typically controlled by a robotic manipulator assembly, which is remotely operated by a user. In one configuration, for example, the actuating mechanism is manipulated by the robotic manipulator assembly to move the jaws of the end effector between an open position and a closed position. In the closed position, the jaws are actuated into compressive contact with the legs of a clip, thereby compressing the clip into a latched or locked position around a vessel or other tissue.

[0054] The end effector 110 comprises a first jaw 111 and a second jaw 112, which are used to move between an open position (as in Fig. (1 shown), in which the jaws are spaced apart from one another and configured in a closed position to force the jaws into compressive contact with the legs of a clamp in order to close and seal the clamp around vessels or tissue. In certain embodiments, the second jaw 112 is a movable jaw configured to move relative to the first jaw 111 from an open position to a closed position. In other embodiments, the first jaw 111 is a movable jaw configured to move relative to the second jaw 112 between an open and a closed position. In still other embodiments, both jaws 111, 112 are movable relative to each other.

[0055] The actuating mechanism may include input couplers (not shown) instead of or in addition to the stationary and movable handles. In certain embodiments, the surgical instrument 100 further comprises a backend mechanism 510 (see Figure 1). Fig. 3A and Fig. 56), which is coupled to the proximal end section of the elongated shaft 105. The backend mechanism typically provides a mechanical coupling between the drive tendons, rods, or cables of the instrument and the motorized axes of the mechanical interface of a drive system. Further details of known backend mechanisms and surgical systems are described, for example, in U.S. Patents Nos. 8,597,280, 7,048,745, and 10,016,244. Each of these patents is hereby incorporated in its entirety by reference.

[0056] The input couplers can be connected to and driven by corresponding output couplers (not shown) of a telemedicine surgical system, such as the system disclosed in U.S. Publication No. 2014 / 0183244A1, the entire disclosure of which is hereby incorporated by reference. The input couplers are driven by one or more input elements (not shown) located within the instrument shaft 105. The input elements are driven by the end effector 110. Suitable input couplers can be designed to pair with various types of motor packages (not shown), such as the stapler-specific motor packages disclosed in U.S. Patent No. 8,912,746 or the universal motor packages disclosed in U.S. Patent No. 8,529,582, the disclosures of which are hereby incorporated in their entirety by reference.Further details of known input couplers and surgical systems are described, for example, in US patents Nos. 8,597,280, 7,048,745, and 10,016,244. Each of these patents is hereby incorporated by reference in its entirety for all purposes.

[0057] Although described here in relation to an instrument configured for use with a robot-assisted surgical system, it should be understood that the actuation and drive assemblies described herein can be integrated into manually operated instruments, electromechanically driven instruments, or instruments actuated by other means. For example, the actuation mechanism may include a grip assembly for user grasping, comprising a fixed handle and a movable handle that serves as the actuating element for the surgical instrument 100.

[0058] With reference to Fig. 2, Fig. 3A and Fig. 3B, the instrument 100 can be provided with a staple magazine 120 comprising several surgical staples 122 and inserted into the surgical instrument 100. In certain embodiments, the magazine 120 can be accessed through a longitudinal slot 124 in the side of the shaft 105 ( Fig. 2) can be inserted. In other embodiments, the magazine 120 can be inserted through a proximal opening 126 of a manual handle or a backend mechanism 510 of the instrument (see Fig. 3A and Fig. 3B). In this latter embodiment, the staple magazine 120 comprises an enlarged distal end 121, which facilitates the advancement of the magazine 120 through an internal channel (not shown) in the back-end mechanism 510 and an internal lumen (not shown) of the instrument shaft 105. The staple magazine 120 may also have a proximal handle 123, which facilitates the user's grasping of the magazine 120, allowing the user to advance the distal end 121 through the shaft 105 to a suitable position immediately proximal to the end effector 110.

[0059] The magazine 120 can contain between about 1 and 20 clips, preferably between about 2 and 12 clips. The clip 122 preferably extends in a substantially parallel direction relative to the longitudinal axis of the shaft 105. The magazine 120 can be made of any suitable material known in the art, for example, a one-piece molded plastic body or a sheet metal construction. The magazine 120 can be designed to accommodate all suitable desired sizes and configurations of clips 122, including conventional clips (e.g., ligature clips made of titanium, tantalum, or stainless steel, such as Horizon™, Hemoclip®, or the like, and / or polymer clips, such as Vas-Q-Clip®, Weck® Hem-o-lok®, or the like). Alternatively, the magazine 120 can be designed to accommodate the clips described below and in Fig. 8A-9D and Fig. The new brackets shown in 34-39B are designed to be 300.

[0060] The wrist assembly 140 is positioned between the end effector 110 and the elongated shaft 105. The wrist assembly 140 can provide a desired amount of movement, for example, + / - 90 degrees in a pitch, yaw, and roll direction, preferably + / - approximately 60 to approximately 65 degrees in the pitch and yaw direction. Cables or other actuators (not shown) are coupled to the wrist assembly 140 and are actuated to transmit movement to the wrist assembly 140. The differential movement of the cables can be used to actuate the wrist assembly 140 to pitch and yaw at various angles. Further details of joint mechanisms that can be used with the embodiments disclosed herein are disclosed in International Publication No. WO 2015 / 127250A1 and US Publication No. 2017 / 0215977 A1, the full disclosures of which are incorporated herein by reference for all purposes.

[0061] In one embodiment, the wrist assembly 140 can include a linkage 142 that provides the pitching movements of the wrist assembly 140. For yaw movements of the wrist assembly 140, the pulleys 419, 431 and linkages 408, 412 (hereinafter referred to as ) are used. Fig. (10D explained) rotated together around a single axis. As in Fig. 4 and Fig. As shown in Figure 16A, the wrist assembly 140 has a first and second inner lumen 146, 148 to allow the movement of a drive element 130 and clamps 122 through it.

[0062] Now, with reference to Fig. 4. The magazine 120 is configured to extend through an internal lumen 132 in the shaft 105, preferably along one side of the shaft 105 (i.e., essentially along one side of the longitudinal axis of the shaft 105). The instrument 100 further comprises a drive element (or clamp feed) 130, which preferably extends through the lumen 132 adjacent to the magazine 120. In certain embodiments, the drive element 130 is arranged on the opposite side of the longitudinal axis from the magazine 120, so that the drive element 130 can move proximally and distally within the shaft 105 relative to the magazine 120, as explained below.In other embodiments, the drive element 130 and the magazine 120 can be arranged on the same side of the longitudinal axis, or the magazine 120 can be centered within the lumen 132 along the longitudinal axis and the drive element 130 can be arranged on both sides next to the magazine 120.

[0063] In certain embodiments, the drive element 130 is coupled to the instrument shaft 105, so that the drive element 130 is included as part of the entire instrument 100, which may be made of materials designed for reuse of the instrument in multiple surgical procedures. In other embodiments, the drive element 130 is coupled to the magazine 120, so that the drive element 130 is included as part of the clamp magazine 120, which may be constructed of materials designed for disposable or single-use applications. In both embodiments, the drive element 130 is configured for longitudinal displacement relative to the shaft 105 to advance the clamps 122 from the magazine 120 to the jaws 111, 112 of the end effector 110, as explained in more detail below.

[0064] As in Fig. 6A and Fig. As shown in Figure 6B, the drive element 130 comprises a proximal component 160 and a flexible component 162, which connects the proximal component 160 to a first and a second clamp engagement element 164, 166. The proximal component 160 is configured to extend through the shaft 105 and can have one or more proximal interfaces 163 (see Figure 6B). Fig. 2) to interact with an actuating mechanism (not shown) to advance the drive element 130 distally and proximally relative to the shaft 105. In certain embodiments, a distal portion of the proximal component 160 may extend through a portion of the wrist assembly 140. In such an embodiment, this distal portion of the proximal component 160 extends, for example, far enough through the wrist assembly 140 to bend at least in the pitch direction, but typically not in the yaw direction. The flexible component 162 typically bends in both the pitch and yaw directions.

[0065] The flexible component 162 preferably comprises a material that is stiff enough to be pressed into the jaws 111, 112 by the wrist assembly 140. At the same time, these components comprise a material that is flexible and elastic enough to bend when the end effector 110 is moved in a pivot-like manner relative to the shaft 105 at the wrist assembly 140. In a preferred embodiment, these components comprise nitinol, polymers such as PEEK, spring steel, or similar materials.

[0066] In one embodiment, the flexible section 160 comprises a first and a second arm 168, 170, each having a clamp engagement element 164, 166 at its distal ends. The engagement elements 164, 166 are configured to extend laterally away from the arms 168, 170, so that they are substantially parallel to the clamp magazine 120 within the shaft 105 (see Fig. 5) are positioned to engage with the clamps 122 (explained below). The arms 168, 170 are preferably designed to move relative to each other between a first position in which the arms are closer together (see Fig. 6A), and can move to a second position in which the arms are further apart relative to the longitudinal axis of the shaft 105 (see, for example, Fig. 12B). In certain embodiments, the arms 168, 170 are essentially parallel to each other in the first position. This allows the arms 168, 170 to move into different positions relative to the staple magazine 122, enabling the engagement elements 164, 166 to engage with one or more staples 122 housed in the magazine 120.

[0067] In one embodiment, the engagement elements 164, 166 each comprise a first disk section 172, which is coupled to or integrally formed with the arms 168, 170. The elements 164, 166 further comprise a central shaft 174, which extends laterally from the disk section 172 and is coupled to a second disk section 176 (so that a shape is formed that essentially resembles a "dumbbell"). The first and second disk sections 172, 176 of the engagement elements 164, 166 preferably have a larger diameter than the central shaft 174, whereby the shaft 174 can be detachably coupled to the clamps 122, as explained in more detail below.

[0068] As in Fig. As shown in Figure 5, the staple magazine 120 comprises a housing 134 with an upper and a lower wall 136, 138 and a longitudinal wall 150 on one side of the housing 134 opposite the drive element 130. The side of the housing 134 opposite the wall 150 is preferably open so that the staples 122 can be seen from this side of the housing 134 and the drive element 130 can interact with the staples inside the magazine 130. The housing 134 further comprises a first and a second distal ramp or tab 154, 156 extending from the distal end of the housing 134. The tabs 154, 156 have sufficient stiffness to force the engagement elements 164, 166 of the drive element 130 to spread out and slide upwards along the tabs 154, 156 when the drive element 130 is pulled in a proximal direction (as explained below).At the same time, the tabs 154, 156 are sufficiently flexible to allow the engagement elements 164, 166 to push through the tabs 154, 156 and advance the clamps 122 through the distal end of the magazine 120 when the drive element 130 is advanced distally and when the drive element 130 is inside the housing 134 (see . Fig. 15B).

[0069] The housing 134 further comprises retaining tabs 180 extending from the longitudinal wall 150 into the interior of the magazine 120. The retaining tabs 180 are spaced apart longitudinally along the housing 120 to define discrete areas for holding each clip 122 within the housing 134 (see Fig. 12A). The retaining tabs 180 preferably have sufficient rigidity to hold the staples 122 within the magazine 120, while at the same time having sufficient flexibility so that a distal displacement of the drive element 130 causes the staples 122 to bend the tabs 180 and each staple 122 to be advanced separately in a distal direction by the drive element 130.

[0070] The housing 134 comprises a series of upper and lower ramps or tabs 182, 184 extending proximal away from the upper and lower walls 136, 138, respectively. Similar to the inner tabs 180, the upper and lower tabs 182, 184 are spaced longitudinally apart along the housing 120, such that they are located above and below each clamp 122 within the housing 134. In certain embodiments, the tabs 182, 184 are pivotably connected to the upper and lower walls 136, 138 to allow proximal movement of the engagement elements 164, 166 over the tabs 182, 184. In other embodiments, the tabs 182, 184 are essentially stationary ramps. In these embodiments, the arms 168, 170 of the drive element 130 are configured to move further apart, so that the elements 164, 166 slide along the ramps 182, 184 when the drive element 130 is moved in a proximal direction.

[0071] The housing 134 further comprises an upper and a lower opening 186, 188 in the upper and lower walls 136, 138, arranged proximal to each upper and lower tab 182, 184. These tabs 182, 184 and openings 186, 188 allow the engagement elements 164, 166 to retract proximally over the tabs 182, 184 and through the openings 186, 188 into the interior of the magazine housing 134, as explained in more detail below. Furthermore, each set of tabs and openings provides a discrete position on the magazine housing associated with one of the clamps. In certain embodiments, the instrument or system may include a control system that detects when the engagement elements 164, 166 of the drive element 130 are located adjacent to each of the clamps inside the magazine. This ensures that the user engages the most distal clamp within the magazine.

[0072] In an alternative embodiment, each of the clamps within the magazine can be advanced distally at the same time. For example, the clamps can be spaced substantially equally apart, and the most distal clamp can be spaced from the jaws by a distance substantially equal to the distance between the clamps. This allows the drive element 130 (or another drive element, such as a shuttle component (e.g., a ratchet and pawl) or a spring (such as a magazine spring)) to advance all the clamps distally by the same distance, enabling, for example, the drive element to advance the most distal clamp to jaws 111, 112, while the next clamp is moved to the position previously occupied by the most distal clamp, and so on.Thus, the drive element can be retracted proximally to the same longitudinal position within the instrument to couple with each staple within the magazine, thereby increasing the speed and efficiency of feeding multiple staples to a target location.

[0073] Fig. Figures 7A-7E show alternative embodiments of the drive element 130. As in Fig. As shown in Figure 7A, a drive element 200 comprises a proximal component 202, a flexible component 204, and a first and a second arm 206, 208 with distal engagement elements 210, 212. In this embodiment, the flexible component 204 comprises wave-like or coiled features that allow the arms 206, 208 to bend towards and away from the longitudinal axis without the material yielding or being permanently deformed.

[0074] Fig. Figures 7B-7E illustrate alternative embodiments of drive elements 220 that include flexible sections 222 designed to provide a better-defined pivot point for each drive element 210. The pivot point of the flexible sections 222 is configured to be located within the wrist assembly 140 of the instrument 100, so that the distal arms 224, 226 can pivot relative to the proximal component 228 of each drive element 210 when the end effector 110 is moved in a pivot-like manner relative to the shaft 105. In some embodiments, the arms 224, 226 can be configured to extend naturally in substantially parallel to each other ( Fig. 7C). In other embodiments, the arms 224, 226 may be configured to naturally have a curved configuration that facilitates the opening and closing of the arms 224, 226 ( Fig. 7B, Fig. 7D and Fig. 7E).

[0075] It will now be discussed with reference to Fig. 8A-9E describes a surgical clamp 300. The clamp 300 comprises a first and a second arm 302, 304, which are pivoted or hinged to move between an open position ( Fig. 8A) and a closed position 306 ( Fig. 8B) are pivotably coupled to one another. The hinge 306 is preferably a live or integral hinge comprising an opening 308 forming two thinned parts connected to the arms 302, 304 to form a pivot bearing that permits the opening and closing of the arms 302, 304. In certain embodiments, the clamp 300 is inherently biased toward the open position and configured to be closed by the force of the jaws 111, 112, as explained below. In other embodiments, the clamp 300 may be inherently biased toward the closed (but not latched) position and configured to be opened and then closed and latched by the jaws 111, 112.

[0076] In certain embodiments, the surgical clip 300 comprises a polymer material, such as a non-absorbable polymer or an absorbable or biodegradable polymer. Suitable materials for the clip 300 include polyoxymethylene (POM), polyester, nylon, polyetheretherketone (PEEK), polyglycolic acid (PGA or PLGA), poly-L-lactic acid (PLLA), polyethylene (PE), or copolymers thereof. In a preferred embodiment, the clip 300 comprises POM.

[0077] The surgical clamp 300 can, for example, be designed for ligating blood vessels in a patient. In certain embodiments, the clamp 300 is dimensioned to ligate vessels with a diameter of approximately 1 mm to approximately 10 mm. In certain embodiments, the clamp 300 is designed with sufficient length, strength, and rigidity to ligate medium to large vessels or vessels with a diameter of up to 10 mm.

[0078] The 300 clamp was designed without laterally protruding ridges, resulting in a thinner profile than conventional polymer clamps. The maximum lateral width of the 300 clamp is less than approximately 2.0 mm, or approximately 0.6 mm to approximately 1.5 mm, or preferably approximately 0.8 mm to approximately 1.1 mm (conventional polymer clamps designed to ligate vessels up to 10 mm in diameter typically have a maximum lateral width of 2.0 mm or more). This allows the user to place the clamps closer together and / or to place more clamps at a target site on the patient, for example, to facilitate better access to the target site.

[0079] It will be evident that the specific dimensions for the maximum lateral width of the 300 clamp vary depending on the clamp's function. For example, if the 300 clamp is designed for clamping smaller vessels (i.e., vessels with a diameter of less than 3 mm), the clamp's width will be less than the dimensions described above. However, the overall length-to-width ratio of the 300 clamp remains higher than that of conventional polymer clamps.

[0080] The first arm 302 includes a detent 310 and the second arm 304 includes a hook 312, so that the clamp 300 can be compressed around a grasped vessel or other grasped tissue into a detented or locked position. In some embodiments, the first and second arms 302, 304 have gripping elements or projections 314 extending on the vessel side of each arm. The projections 314 are preferably spaced apart from one another along each arm and provide gripping surfaces for securing the clamp 300 to the vessel once it is locked in the closed position. These gripping surfaces can also resist axial displacement of the clamp.

[0081] Now, with reference to Fig. 9B and Fig. 9C, the latch 310 comprises a main body 342 dimensioned to slide in a slot 340 in the hook 312, defined by the first and second arms 350, 352. The latch 310 further comprises a locking projection 344 extending laterally outward from the main body 342 and including a recess 346. When the latch 310 is pressed against the hook 310 by the jaws 111, 112, the force exerted is sufficient to temporarily deform the hook 310 backward away from the latch 310. This allows the locking projection 344 to pass below the slot 340 in the hook 310. Once this has happened, the hook 310 returns to its original position, so that the projection 344 is located below the slot 340 and the shelf 346 is in a bottom 348 (see Fig. 9A) one of the arms 350, 352 engages. This secures the locking device 310 to the hook 312 and provides the user with both visual and audible confirmation that the locking device 310 is now attached to the hook 312.

[0082] The clamp 300 also includes one or more centering features for aligning the detent 310 with the hook 312 when the clamp 300 is closed by the jaws 111, 112. As in Fig. As shown in Figure 9D, the latch 310 includes a rib 334 extending from an inner or vessel-side surface of the main body 342 of the latch 310. The rib 334 extends downward along the vessel-side surface of the latch 310 and is configured to engage the surfaces that partially surround the slot 340 in the hook 312 (see Figure 9D). Fig. 9C). The rib 334 aligns the detent 310 with the instrument on the hook 312 during the locking process to ensure that the staple 300 is in the correct position for locking. This configuration allows for a thinner staple profile, as no protruding projections are required, such as those typically found on conventional polymer staples.

[0083] With reference to Fig. 8A and Fig. 9A, the locking device 310 on the first arm 302 includes an engagement element 320 for releasable coupling with the engagement element 164 of the drive element 130, and the hook 312 on the second arm 304 includes an engagement element 322 for releasable coupling with the engagement element 166 of the drive element 130 (see Fig. 15A). The engagement elements 320, 322 preferably allow the engagement elements 164, 166 to secure the drive element 130 to the clamp 300 during the feed of the clamp 300 through the wrist 140 into the jaws 111, 112, and to control and hold the clamp 300 during the opening and closing of the jaws 111, 112 (and consequently the opening and closing of the clamp 300), as well as any other joint-like movement of the end effector 110 relative to the shaft 105 (i.e., roll, yaw, or pitch movements of the end effector). At the same time, the engagement features 320, 322 are designed to release the engagement elements 164, 166 when sufficient force is applied to the drive element 130. As explained below, this allows the user to remove the drive element 130 from the clamp 300 after the clamp 300 has been closed on a container.

[0084] A particular advantage of this feature is that the drive element 130, captured in the jaws 111, 112, allows the drive element 130 and / or the jaws 111, 112 to open the staple 300 while it is in the jaws. Conventional polymer staples tend to creep over time when stored in the staple magazine (i.e., they move into a more closed position). This prevents the staples from opening spontaneously after being advanced into the jaws (as typically occurs with conventional polymer staples). This feature also facilitates the relocation of the key positioning (protrusion) features from the staple to the drive element, enabling the design of a staple with a thinner profile than conventional staples (explained in more detail below).Furthermore, this feature allows the connection between the engagement elements 164, 166 of the drive element 130 and the engagement features 320, 322 of the clamp 300 to rotate while the jaws 111, 112 open and close.

[0085] In one embodiment, the engagement features 320, 322 each comprise a snap-in feature comprising a recess or opening 324 dimensioned to accommodate the shaft 174 of the engagement elements 164, 166, and projections 326 on both sides of the openings 324 forming a reduced-diameter inlet to the openings 324 (see Fig. 9A and Fig. 9D). This allows the shafts 174 of the engagement elements 164, 166 of the drive element 130 to be advanced into the openings 324 with sufficient force (explained below). At the same time, the shafts 174 remain fixed in the openings 324 until sufficient retraction force is exerted on the drive element 130.

[0086] In certain embodiments, the first and second arms 302, 204 comprise conical ribs 330 extending towards the non-vessel side of the arms (see Fig. 8C, Fig. 8D, Fig. 9A and Fig. 9B). These ribs 330 taper in two directions (i.e., laterally and vertically) to provide lateral and vertical guidance features for the drive element 130, enabling it to align the engagement elements 164, 166 of the drive element 130 with each clamp 300. Specifically, the ribs 330 taper inward from each lateral side in a proximal direction to provide lateral alignment. Furthermore, the ribs 330 taper proximally toward the arms 302, 304 to provide vertical alignment. This allows the drive element 130 to center and / or align itself on the clamp 300 during engagement with the magazine 120.

[0087] The clamp 300 was designed such that the force required to release the latch 310 from the hook 312 after it has engaged is greater than the force required to release the drive element 130 from the clamp 300 (i.e., the latching mechanism is stronger than the engagement mechanism). Thus, the locking projection 344 of the latch 310 secures the latch 310 to the hook 312 when the drive element 130 is retracted proximally and the engagement elements 164, 166 are retracted from the engagement elements 322, 320 of the clamp 300.

[0088] The clamp 300 further has a projection 332 extending from the side of the hook 312, which facilitates the guidance of the clamp 300 by a guide rail 442 of the jaw 404 when the clamp 300 is advanced into the jaws (see Fig. 11A). In one embodiment, the locking projection 344 on the detent 310 is configured to also function as a guide projection that moves forward along the guide rail 440 of the jaw 402. The projections 332, 344 can also serve to engage in the rails 440, 442 of the jaws 402, 404 when the drive element 130 disengages from the clamp 130 during the advancement, thereby preventing premature disengagement of the clamp 300 from the jaws 111, 112. These projections 332 are preferably thinner than the projections of conventional clamps.

[0089] The clamp 300 also includes an anti-shearing feature that ensures the latch 310 remains aligned after locking with the hook 312. This feature comprises a fin 354 extending across the top of the main body 342 of the latch 312. When the latch 310 is locked with the hook 312, the fin 354 is wedged in the slot 340 of the hook 312, thus preventing any shearing movement that could cause the latch to disengage from the hook (see Fig. 9E). By providing a fin 354 that fits into a slot 340, a thinner clamp construction can be achieved than with conventional clamps, which typically use hub-like projections around the hook to reduce shearing motion.

[0090] It will now be discussed with reference to Fig. References 10A-10E describe an embodiment of a jaw assembly 400 for the instrument 100. As shown, the jaw assembly 400 comprises a first and a second jaw 402, 404, which are pivotably coupled to each other by a hinge joint 406. The first and second jaw 402, 404 can also be connected to each other by a hinge joint about an axis that is substantially perpendicular to the longitudinal axis (e.g., the pitch axis), as shown in Fig. 11A shown. Furthermore, the first and second jaws 402, 404 are designed to move relative to each other between an open position (as in Fig. 10A and Fig. 10B) and can move into a closed position in which the distal ends of the jaws are close together or touching (see Fig. 10C). In the preferred embodiment, both jaws 402, 404 are movable jaws, although it will be recognized that one of the jaws may be a movable jaw configured to move relative to the other jaw between an open and a closed position.

[0091] In a preferred embodiment, the hinge 406 comprises a first connecting element 408 and a second connecting element 410 on one side of the jaw assembly 400 and a third connecting element 412 on the other side of the jaw assembly 400 (see Fig. 10D). The first connecting link 408 comprises a slotted pin 414 configured to slide through a slot 415 of the first jaw 402, and a pin or screw 419 coupled to a first pulley 421. Similarly, the second connecting link 410 comprises a slotted pin 416 configured to slide through a slot 417 of the second jaw 404 (see Fig. 10B), and a pin or screw 423 coupled to the first pulley 421.

[0092] As in Fig. As shown in Figure 10D, the third connecting member 412 is positioned on the other side of the jaws 402, 404 and comprises a slotted pin 425 configured to slide through a slot 427 of the first jaw 402 on the other side of the slot 415. In the preferred embodiment, the slotted pin 425 is the same slotted pin as the slotted pin 414 and extends completely through the jaw 402 from the first connecting member 408 to the third connecting member 412. The third connecting member 411 has a further pin or screw 429 which is coupled to a second pulley 431 opposite the first pulley 419.

[0093] In one embodiment, the jaw assembly 400 comprises a pulley and linkage system based on a single axis, with both the jaw joint and the wrist yaw being rotated. The single pivot point helps to minimize gaps that can form between sections of the linkage and that can make it difficult to advance clamps into the jaws 402, 404. The slots in the jaws are advanced by an axis in the corner of a four-bar linkage. Each jaw has its own four-bar linkage, which is essentially the same (but reversed), extends between the two pulleys, and acts as a differential. As shown in Fig. As shown in Figure 10D, the pulley 419 acts as the first "connecting link" in the four-bar linkage, the first connecting link 408 as the second "connecting link", the third connecting link 412 as the "third connecting link", and the second pulley 431 as the fourth connecting link. The slotted pin 414, 425 is the "pivot point" between the second and third connecting links of the four-bar linkage.

[0094] When both pulleys are driven together in the same direction, the jaws 402 and 404 rotate together in the yaw direction relative to the shaft 105. However, any differential movement between the pulleys drives the linkages to move the jaws relative to each other (i.e., to open and close them). The linkages can also be located near the shear point of the connecting links so that they amplify the force when closing the clamp (similar to a vise). A more detailed description of this feature can be found in the jointly assigned, pending U.S. preliminary application (Attorney File No. P06660-US-PRV), filed concurrently with this application.

[0095] Again with reference to Fig. 11A, the jaw assembly 400 comprises a first and second strip, band, wire, or cable 420, 422, extending from the wrist assembly 140 to the first and second jaw 402, 404, respectively. The bands 420, 422 preferably comprise a flexible material, such as nitinol, spring steel, or the like, so that the bands 420, 422 bend or flex when the jaws 402, 404 are moved joint-like about the jaw axis. The bands 420, 422 each have a proximal end 426, 428, which is coupled to the wrist assembly 140, and a distal end 430, 432, which extends into the first and second jaw 402, 404, respectively. In certain embodiments, the distal ends 430, 432 can be attached to the jaws 402, 404 or otherwise coupled to them.In other embodiments, the bands 420, 422 extend on the inside of the slotted pins 416, 414 and have sufficient stiffness to remain in place within the jaws 402, 404.

[0096] As in Fig. 11A and Fig. As shown in Figure 11B, the bands 420 and 422 serve to hold the drive element 130 and the clamp 300 when these components have been driven into the jaws 402 and 404 and the jaws are moved joint-like about the yaw axis of the instrument. More precisely, the distal advance of the drive element 130 (and the clamp 300 with it) occurs between the bands 420 and 422, even when the jaws 402 and 404 are moved joint-like relative to the longitudinal axis of the instrument 100 (see Figure 11B). Fig. 11A).

[0097] As in Fig. 11A and Fig. As shown in Figure 18, the first and second jaws 402, 404 each comprise guide rails 440, 442, which generally extend from a proximal section of the jaws to the distal end 434, 436 of each jaw. The guide rails 430, 432 generally extend within the ligaments 420, 422. The guide rails 430, 432 and the ligaments 420, 422 ensure that the arms 168, 170 of the drive element 130 extend along the guide rails 430, 432 to the distal ends 434, 436 when the drive element 130 is advanced distally into the jaws 402, 404.

[0098] Now, with reference to Fig. 10E, the jaws 402, 404 can each have an engagement feature at their distal ends to secure the staples therein after they have been fed by the drive element 130. In one embodiment, the engagement features comprise ramp-shaped leaf springs 437 positioned on both sides of the guide rails 440, 442. As shown, the guide rails 440, 442 taper inward distally, so that the lateral width decreases distally along the guide rails 440, 442. As the engagement elements 164, 166 of the drive element 130 and the staple move distally through the guide rails 440, 442, they contact the outer surfaces 439, 441 of the guide rails 440, 442, which narrow as the staple is advanced distally.The clamp and the engagement elements 164, 166 press against leaf springs 437, thus pre-tensioning them outwards, allowing the clamp and the engagement elements 164, 166 to move towards the distal ends of the jaws. This inward spring pressure exerted by the leaf springs 437 holds the clamp and the engagement elements 164, 166 within the distal ends of the jaws and prevents them from retracting proximally and / or falling out of the jaws.

[0099] As in Fig. 10, Fig. 19B and Fig. As shown in Figure 20B, the jaws 402, 404 each have distal end sections 434, 436, which include a cutout 454. The cutouts 454 are arranged at the distal end of the guide rails 430, 432. The cutouts 454 preferably have a larger cross-sectional area than the tracking guide rails 430, 432. This ensures that the distal ends of the detent 310 and the hook 312 of the clamp 300 have sufficient clearance when coupled to the jaws 402, 404 (since these elements are generally distal to the engagement elements 164, 166 of the drive element 130 when the clamp 300 is advanced distally into the jaws 402, 404). Furthermore, the cutouts 454 facilitate the removal of the clamp 300 from the jaws 402, 404 when the clamp 300 is closed and latched and the drive element 130 has been decoupled from the clamp 300.

[0100] In a Fig. In the embodiment shown in Figure 19B, the cutouts 454 each comprise a longitudinal component 456 for receiving the hook 312 and the detent 310 of the clamp 300 and a horizontal component 448 for receiving the engagement elements 164, 166 of the drive element 130. The horizontal components 448 are dimensioned and configured such that they contain the engagement elements 164, 166 within the jaws 402, 404 (i.e., they prevent the engagement elements 164, 166 from passing distal to the jaws 402, 404). In certain embodiments, the horizontal components 448 have a lateral span that is smaller than the total lateral span of the engagement elements 164, 166 (i.e., from one end of the outer shaft 172 to the other end of the outer shaft 176). In other embodiments, the horizontal components 448 have a longitudinal span that is smaller than the diameter of the outer shafts 172, 176 of the engagement elements 164, 166.In certain embodiments, both the longitudinal and lateral spans of the horizontal components 448 are small enough to accommodate the engagement elements therein.

[0101] It will now be discussed with reference to Fig. 4, 5 and 12A-21 describe a procedure for applying multiple staples to tissue or vessels in a patient. As in Fig. 4 and Fig. As shown in Figure 5, the drive element 130 is generally positioned along the side of the magazine 120 such that the engagement elements 164, 166 are located distal to the tabs 154, 156 at the distal end of the magazine 120. To engage a clamp 300 with the drive element 130, the drive element 130 is retracted proximally so that the engagement elements 164, 166 slide along the tabs 154, 156 and the arms 168, 170 of the drive element 130 spread out so that the engagement elements 164, 166 slide along the upper and lower surfaces 136, 138 of the magazine 120 (see Figure 5). Fig. 12A and Fig. 12B).

[0102] Now, with reference to Fig. 13A and Fig. 13B, the engagement elements 164, 166 slide over the tabs 182, 184 of the first clamp 300 within the magazine 130 when the drive element 130 is retracted proximally. In some embodiments, the tabs 182, 184 are configured to spring inwards to facilitate the movement of the engagement elements 164, 166 over the tabs 182, 184. In other embodiments, the arms 168, 170 are extended further outwards to allow this movement.

[0103] Now, with reference to Fig. 14A and Fig. 14B, the engagement elements 164, 166, once they are proximal to the tabs 182, 184, will enter the openings 186, 188 into the interior of the magazine 130. In some embodiments, this movement occurs automatically as the engagement elements 164, 166 pass proximal to the tabs 182, 184. In other embodiments, the drive element 130 can be advanced distally to move the engagement elements 164, 166 into the openings 186, 188. The upper and lower tabs 182, 184 generally guide the engagement elements 164, 166 downwards into the magazine 120.

[0104] As in Fig. As shown in Figures 15A-15C, the drive element 130 is then moved further distally until the engagement elements 164, 166 engage with the engagement features 320, 322 of the first clamp 300A (see also Fig. 9) More precisely, the inner shaft 174 of each element 162, 164 passes through the snap-in design of features 320, 322, through the projections 326 and into the openings 324 of the detent 310 and the hook 312 of the clamp 300. As the drive element 130 moves further distally, the retaining tab 180 is bent away, releasing the clamp 300A from the magazine 120. At this point, the first clamp 300A is coupled to the drive element 130 and is no longer secured in the magazine 120, allowing the drive element 130 to move the clamp 300 into the end effector 110. The proximal clamp 300B remains secured in the magazine 120.

[0105] Now, with reference to Fig. 16A and Fig. 16B, the drive element 130 pushes the clamp 300 through the central lumens 146, 148 within the wrist assembly 140 and into the end effector 110. When the arms 168, 170 of the drive element 130 enter the jaw assembly 400, the bands 420, 422 restrict the movement of the arms 168, 170 such that the arms 168, 170 enter the guide rails 440, 442 of the first and second jaw 402, 404 (see Fig. 17 and Fig. 18). The drive element 130 is advanced distally until the engagement elements 164, 166 (and the hook 312 and the detent 310 of the clamp 310A) engage in cutouts 454 in the distal end sections 434, 436 of the jaws 402, 404 (see Fig. 19A and Fig. 19B).

[0106] Now, with reference to Fig. 20A and Fig. 20B, the jaws 402, 404 are closed when the surgeon has positioned the first clamp 300A at the desired location to clamp tissue or a vessel. As mentioned above, the jaws 402, 404 provide sufficient force to close the clamp 300A and secure the detent 310 in the hook 312. Once this has occurred, the drive element 130 can be retracted proximally by applying sufficient force to the element 130 to retract the engagement elements 162, 164 of the drive element 130 from the engagement elements 320, 322 of the detent 310 and the hook 312, respectively. Once the drive element 130 has been disengaged from the clamp 300A, the drive element 130 can be retracted proximally through the wrist assembly 400 and into the shaft 105 of the instrument (see Fig. 20A).

[0107] Now, with reference to Fig. 21. To engage a second stapler 300B from magazine 120, the engagement elements 164, 166 of the drive element 130 are retracted over the distal tabs 154, 156 and past the first upper and lower tabs 182a, 184a and the second upper and lower tabs 182b, 184b to the second stapler 300B. The process can then be repeated to advance the second stapler 300B to the jaws of the end effector, then a third stapler 300C, and so on.

[0108] Fig. Figure 22 shows the distal end section of an alternative embodiment of a surgical instrument 1100 according to an illustrative embodiment. The surgical instrument 1100 comprises an end effector 1110, an elongated shaft 1105, and a wrist assembly 1140 that couples the end effector 1110 to the shaft 1105. The proximal end section of the elongated shaft 1105 is operatively connected to an actuating mechanism (not shown), although a person skilled in the art reading this description will recognize that components of the actuating mechanism may extend into and / or pass through the elongated shaft 1105 and / or the wrist assembly 1140.

[0109] The end effector 1110 comprises a first jaw 1111 and a second jaw 1112, which are used to move between an open position (as in Fig. 22), in which the jaws are spaced apart from one another and configured in a closed position to bring the jaws into compressive contact with the legs of a clamp in order to close and seal the clamp around vessels or tissue. In certain embodiments, the second jaw 1112 is a movable jaw configured to move relative to the first jaw 1111 from an open position to a closed position. In other embodiments, the first jaw 1111 is a movable jaw configured to move relative to the second jaw 1112 between an open and a closed position. In further embodiments, both jaws 1111, 1112 are movable relative to each other.

[0110] Now, with reference to Fig. 23 and Fig. 24, the instrument 1100 can be provided with a staple magazine 1120 comprising several surgical staples 1122 and inserted into the surgical instrument 1100. In certain embodiments, the magazine 1120 can be accessed through a longitudinal slot 1124 in the side of the shaft 1105 ( Fig. 23 and Fig. 27). In other embodiments, a magazine 1120A can be inserted through an opening in a proximal end 1126 of the shaft ( Fig. 24 and Fig. 28) are used. The magazine 1120 can contain between about 1 and 20 clamps, preferably between about 2 and 12 clamps. The clamp 1122 preferably extends in a substantially parallel direction relative to the longitudinal axis of the shaft 1105.

[0111] Magazine 1120 can be manufactured from any suitable material known in the art, for example, from a one-piece molded plastic body or from sheet metal. Magazine 1120 can be designed to hold all suitable desired sizes and configurations of staples 1122, including conventional staples (e.g., ligature staples made of titanium, tantalum, or stainless steel, such as Horizon™, Hemoclip®, or the like, and / or polymer staples, such as Vas-Q-Clip®, Weck® Hem-o-lok®, or the like). Alternatively, Magazine 1120 can be designed to hold the staples described herein and in Fig. 8A-9D and Fig. The new brackets shown in 34-39B are designed to be 1300.

[0112] The wrist assembly 1140 is positioned between the end effector 1110 and the elongated shaft 1105. The wrist assembly 1140 can provide a desired amount of movement, for example, + / - 90 degrees in a pitch, yaw, and roll direction (explained in more detail below). Cables or other actuators (not shown) are coupled to the wrist assembly 1140 for drive and are actuated to transmit movement to the wrist assembly 1140.

[0113] In certain embodiments, the drive element 1130 is coupled to the instrument shaft 1105, so that the drive element 1130 is included as part of the entire instrument 1100, which may be constructed of materials designed for reuse of the instrument in multiple surgical procedures. In other embodiments, the drive element 1130 is coupled to the magazine 1120, so that the drive element 1130 is included as part of the clamp magazine 1120, which may be made of materials designed for disposable or single-use applications. In both embodiments, the drive element 1130 is configured for longitudinal displacement relative to the shaft 1105 to advance the clamps 1122 from the magazine 1120 to the jaws 1111, 1112 of the end effector 1110, as explained in more detail below.

[0114] As in Fig. 25, Fig. 26A and Fig. As shown in Figure 26B, the staple magazine 1220 comprises a housing 1134 with upper and lower walls 1136, 1138 for holding several staples 1122 within the housing 1134. The housing 1134 further comprises a series of internal chambers 1150 for receiving each staple (in Fig. 26A (designated 1122A, 1122B, and 1122C) within the housing 1134. The inner chambers 1150 are preferably spaced substantially equally apart, and the most distal chamber 1150, which receives the most distal staple 1122A, is preferably spaced from the jaws 1111, 1112 by a distance substantially equal to the distance between the staples. This allows the drive element 1130 to move all staples distally forward by the same distance, enabling, for example, the drive element 1130 to move staple 1122A forward to the jaws 1111, 1112, while staple 1122B is moved to the position previously occupied by staple 1122A, and so on. This design increases the speed and efficiency of feeding multiple staples to a target location. Further details of this process are explained below.

[0115] The housing 1134 can have one or more longitudinal walls extending between the upper and lower walls 1136, 1138. In one embodiment, the housing 1134 includes a longitudinal wall 1152 on the opposite side of the feed tabs 1182 of the drive element 1130 (see Fig. 26C; is explained in more detail below). The housing 1134 may also have a second longitudinal wall (not shown) on the side adjacent to the feed tabs 1182, or this side may be substantially open (or have windows or openings within the second longitudinal wall) so that the feed tabs 1182 of the drive element 1130 can access the clamps 1122 from this side of the housing 1134, as shown in Fig. 26B and Fig. 26C shown.

[0116] In one embodiment, the housing 1134 may further comprise overhang features 1154 extending from each side of the upper and lower walls 1136, 1138 in the direction of the longitudinal axis (see Fig. 26B). These overhang features ensure that the staples remain within the magazine housing 1134, but still allow distal movement of the staples through the housing 1134. The upper and lower overhang features 1154 are preferably spaced sufficiently apart to hold the staples 1122 within the housing 1134, while the feed tabs 1182 and the retaining tabs 1170, 1172 of the drive element 1130 can access the staples (discussed below).

[0117] As in Fig. As shown in Figure 29A, the magazine 1120 comprises a series of ratchet tabs 1183 positioned proximal to each staple 1300. The ratchet tabs 1183 are biased inwards and ensure that the staples are not pulled backward or proximally when the drive element 1130 retracts proximally to engage another staple. Simultaneously, the ratchet tabs 1183 form a ramp-shaped surface that allows the staples positioned proximal to each ratchet tab to move distally along the ramp to the next most distal position to engage with the drive element 1130.

[0118] As in Fig. As shown in Figures 30-32, the drive element 1130 comprises a proximal component 1160, a distal component 1164, and a flexible component 1162 that couples the proximal component 1160 to the distal component 1164. The distal component 1164 is generally configured for releasable connection to one or more of the surgical clamps 1122 in the magazine 1120 (explained below). The proximal component 1160 is configured to extend through the shaft 105 and may have one or more proximal interfaces (not shown) to interact with an actuating mechanism (not shown) to advance the drive element 1130 distally and proximally relative to the shaft 1105.

[0119] The flexible component 1162 preferably comprises a material that is sufficiently rigid to possess enough compressive strength to be pressed into the jaws 1111, 1112 via the wrist assembly 1140. At the same time, the flexible component 1162 comprises a material that is flexible and elastic enough to bend when the end effector 1110 is moved in a pivot-like manner relative to the shaft 1105 at the wrist assembly 1140. In a preferred embodiment, the flexible component 1162 comprises nitinol, polymers such as PEEK, spring steel, or similar materials.

[0120] In one embodiment, the flexible component 1162 comprises several rods 1168 extending between the proximal and distal components 1160, 1164, and being at least as long as the wrist assembly 1140. The rods 1168 are configured to bend when the wrist assembly 1140 moves the end effector 1110 relative to the shaft 1105 in a hinge-like manner, so that the distal component 1164 of the drive element 1130 can be positioned inside the end effector 1110 when the wrist assembly 1140 moves in a hinge-like manner. This allows the drive element to position the clamps 1122 within the jaws 1111, 1112 of the end effector 1110 and hold the clamp 1122 while the jaws 1111, 1112 are opened and closed and / or moved joint-like relative to the shaft of the instrument.This allows the surgeon to fully open the clamps after they have been advanced into the jaws, enabling effective positioning around a target vessel or tissue. Furthermore, the surgeon can reposition the jaws relative to the shaft after advancing the clamp.

[0121] Fig. Figures 33A-33C illustrate alternative embodiments of a flexible component of the drive element 1130. As shown in Fig. As shown in Figure 33A, a flexible component 1162A comprises several belts 1168A extending between the distal and proximal components of the drive element 1130. The belts 1168 can have any suitable shape, for example, circular, rectangular, square, or the like. In one embodiment, the belts 1168 are essentially rectangular and comprise nitinol, a stainless steel spring, or a similar material.

[0122] Fig. Figure 33B illustrates another embodiment of the flexible component 1162B, which includes laser-cut tubes to form an accordion-like shape that allows the flexible component 1162B to bend relative to the distal and proximal components of the drive element 1130. Fig. Figure 33C illustrates a further embodiment of the flexible component 1162C, comprising a flexible catheter-like structure formed from a reinforced polymer sheath material. The retaining tabs 1170C, 1172C and the flexible tabs 1174C, 1176C can be formed, for example, by cutting out the sheath material.

[0123] With reference to Fig. 31, the distal component 1164 of the drive element 1130 comprises an engagement element for releasably coupling the drive element 1130 with the surgical clamp within the magazine 1120. In one embodiment, the engagement element comprises a first and a second retaining tab 1170, 1172, which extend distally from the drive element 1130. The retaining tabs 1170, 1172 are located on the lateral sides of the drive element 1130 and are preferably biased inwards with sufficient force in the direction of the longitudinal axis of the shaft 1105 to retain and control a clamp 1122 held within the tabs 1170, 1172 (see, for example, Figure 31). Fig. 36A and Fig. 36B).

[0124] In certain embodiments, the distal component 1164 further comprises upper and lower retaining tabs 1174, 1176, which extend distally from the drive element 1130 and are spaced apart from each other above and below the retaining tabs 1170, 1172. The retaining tabs 1174, 1176 are located on the upper and lower sections of the drive element 1130 and are biased inwards to further secure the coupling of the drive element 1130 to the clamp 1122 (in addition to the tabs 1170, 1172). The tabs 1174, 1176 can also serve to guide the drive element 1130 within the clamp magazine 1120 by bending upwards and downwards when the drive element 1130 is retracted proximally into the housing 1134 of the magazine 1120 (see Fig. 26B).

[0125] The distal component 1164 also includes an annular collar 1178, which forms a structure for the retaining tabs 1170, 1172, 1174, and 1176. The collar 1178 is dimensioned to slide around the magazine housing 1120. Furthermore, the collar 1178 is dimensioned to fit through the inner tube 1430 of the wrist assembly 1140 (explained in more detail below).

[0126] With reference to Fig. 26C and Fig. 32, the proximal component 1160 of the drive element 1130 comprises a structural frame 1180 dimensioned to slide around the housing 1134 of the staple magazine 1120. The proximal component 1160 further comprises a series of feed tabs 1182 on both sides of the magazine 1120 (see also Fig. 32), which are biased inwards in the direction of the longitudinal axis of the shaft. The feed tabs 1182 are configured to engage inwards behind the proximal clamps 1122B, 1122C, etc., within the magazine 1120, so that the distal feed of the drive element 1130 simultaneously also advances the proximal clamps when the most distal clamp 1122A is advanced into the jaws 1111, 1112. As explained above, the clamps within the magazine 1120 are evenly spaced, so that advancing the distal clamp 1122A into the jaws 1111, 1112 also advances the next proximal clamp 1122B to the previous position of the distal clamp 1122A. This brings the clamp 1122B into a position in which the retaining tabs 1170, 1172 can engage in it when the drive element 1130 is retracted proximally after being released from the distal clamp 1122A (as described below).

[0127] With reference to Fig. 34-39C describes various embodiments of a surgical clamp 1300. As in Fig. As shown in Figures 34-36B, an embodiment of a clamp 1300 comprises a first and a second arm 1302, 1304 which are pivotably coupled to each other about a pivot point or a hinge 1306 in order to switch between an open position ( Fig. 35A) and a closed position ( Fig. 35B). The hinge 1306 is preferably a live or integral hinge with an opening 1308 forming two thinned parts connected to the arms 1302, 1304 to form a pivot bearing that allows the arms 1302, 1304 to open and close. In certain embodiments, the clamp 1300 is inherently biased toward the open position and configured to close by the force of the jaws 1111, 1112, as explained below. In other embodiments, the clamp 1300 may be inherently biased toward the closed (but not latched) position and configured to open and then be closed and latched by the jaws 1111, 1112.

[0128] In certain embodiments, the surgical clip 1300 comprises a polymer material, such as a non-absorbable polymer or an absorbable or biodegradable polymer. Suitable materials for the clip 300 include polyoxymethylene (POM), polyester, nylon, polyetheretherketone (PEEK), polyglycolic acid (PGA or PLGA), poly-L-lactic acid (PLLA), polyethylene (PE), or copolymers thereof. In a preferred embodiment, the clip 300 comprises polyoxymethylene (POM). The surgical clip 1300 can, for example, be designed to ligate blood vessels in a patient. In certain embodiments, the clip 1300 is dimensioned to ligate blood vessels with a diameter of approximately 3 mm to approximately 10 mm.

[0129] The first arm 1302 includes a detent 1310 and the second arm 1304 includes a hook 1312, so that the clamp 3100 can be compressed into a detented or locked position around a captured vessel or other captured tissue. In some embodiments, the first and second arms 1302, 1304 include gripping features or projections 1314 extending on the vessel side of each arm. The projections 1314 are preferably spaced apart from one another along each arm and provide gripping surfaces for securing the clamp 1300 to the vessel once it is locked in the closed position. These gripping surfaces can also resist axial displacement of the clamp.

[0130] Now, with reference to Fig. 35A and Fig. 35B, the detent 1310 comprises first and second projections or hubs 1320, 1322, which extend laterally outward from the detent 1310. When the detent 1310 is pressed against the hook 1310 by the jaws 1111, 1112, the force exerted is sufficient to temporarily deform the hook 1310 backward away from the detent 1310. This allows the locking hubs 1320, 1322 to pass under the hook 1312. Once this has happened, the hook 1310 returns to its original position, so that the hubs 1320, 1322 are located below the hook 1310 and an underside 1324 of the hook 1310 engages in the hubs to attach the latch 1310 to the hook 1312 and to confirm to the user both visually and audibly that the latch 1310 is now attached to the hook 1312.

[0131] The clamp 1300 can be designed such that the force required to remove the detent 1310 from the hook 1312 after it has engaged thereon is greater than the force required to remove the drive element 1130 from the clamp 1300 (i.e., the detent mechanism is stronger than the engagement mechanism). Thus, the hubs 1320, 1322 of the detent 1310 secure the detent 1310 to the hook 1312 when the drive element 1130 is retracted proximally and the engagement tabs 1170, 1172 are retracted from the clamp 1300. In an alternative embodiment, the jaws of the instrument have an engagement feature that secures the clamp 1300 to the jaws when the drive element 1130 is retracted proximally and disengages from the clamp (explained in more detail below).

[0132] As in Fig. As shown in Figure 35A, the clamp 1300 further comprises a projection 1332 extending from both sides of the hook 1312 and facilitating the guidance of the clamp 1300 by a guide rail 1442 of the jaw 1404 when the clamp 1300 is advanced into the jaws (see Figure 35A). Fig. 50B). In one embodiment, the hubs 1320, 1322 on the detent 1310 are configured to also function as a guide projection that moves forward along the guide rail 1440 of the jaw 1402. The function of the hub is to engage in the rails 1440, 1442 of the jaws 1402, 1404 when the drive element 1130 disengages from the clamp 1130 during the advancement, thereby preventing premature disengagement of the clamp 1300 from the jaws 1111, 1112.

[0133] In certain embodiments, the arms 1302, 1304 of the clamp 1300 each comprise one or more projections 1326 extending from a proximal section of the arms (distal to the hinge 1306). In one embodiment, a projection 1326 extends on both sides of each of the arms 1302, 1304. The projections 1326 are designed to engage in the feed tabs 1182 of the drive element 1130. In particular, the feed tabs 1182 are designed to engage directly proximal to the projections 1326, inwardly against the clamp 1300. Since the tabs 1182 are pre-tensioned inwards, a distal movement of the drive element 1130 causes the tabs to touch and engage a proximal side of the projections 1326, allowing the drive element 1130 to advance the clamps within the magazine 1120 (see Fig. 26C).

[0134] Fig. 36A and Fig. Figure 36B illustrates the coupling of the drive element 1130 with a clamp 1300. As shown, the retaining tabs 1170, 1172, 1174, 1176 are biased inwards so that they clamp onto a proximal end section of the clamp 1300 (around the hinge 1306). This allows the drive element 1130 to hold and control the clamp 1300 as it moves distally through the wrist assembly 1140 into the end effector 1110. Furthermore, the drive element 1130 can maintain control over the clamp 1300 when the arms 1302, 1304 of the clamp 1300 are opened within the jaws 1111, 1112.

[0135] Fig. 37A and Fig. Figure 37B illustrates an alternative embodiment of the clamp 1300A and the distal component 1164A of the drive element 1130A. As shown, the clamp 1300A includes a proximal handle 1360 to facilitate engagement with the retaining tabs 1170A, 1712A of the drive element 1130A. The drive element 1130A may further include an internal recess 1362, which is arranged between the tabs 1170A, 1170B and is designed to engage with a distal projection 1364 on the handle 1360 and to detachably couple with it. This design ensures a secure coupling between the distal component 1164A of the drive element 1130A and the clamp 1300A.

[0136] Fig. Figures 38A-38C illustrate a further embodiment of a drive element 1130B and a clamp 1300B. As shown, the clamp 1300B comprises a proximal handle 1370 with an engagement means 1372, which is designed to be detachably coupled to an internal recess or engagement feature 1374, which is arranged within the retaining tabs 1170B, 1172B of the drive element 1130B.

[0137] Fig. 39A and Fig. Figure 39B illustrates a further embodiment of a drive element 1130C and a clamp 1300C. In this embodiment, the clamp 1300C comprises a proximal opening 1181 dimensioned to receive the retaining tabs 1170C, 1172C of the drive element 1130C. In this embodiment, the retaining tabs 1170C, 1172C can be biased outwards from the longitudinal axis. Thus, the retaining tabs 1170C, 1172C are moved distally into the proximal opening 1181 and then biased outwards to secure the clamps 1170C, 1172C within the opening 1181.

[0138] It will now be discussed with reference to Fig. Figures 40A-40D describe an embodiment of a jaw assembly 1400. The jaw assembly 1400 can be used with the instrument 100, the instrument 1100, or any other suitable stapler applicator instrument. As shown, the jaw assembly 1400 comprises a first and a second jaw 1402, 1404, which are pivotably coupled to each other on a first and a second pivot pin 1407, 1409. The first and second jaw 1402, 1404 are preferably designed to move relative to each other between an open position (as shown in Figure 40A-40D). Fig. 40A) and can move into a closed position in which the distal ends of the jaws are essentially parallel to each other (see Fig. 40B). In the preferred embodiment, both jaws 1402, 1404 are movable jaws, although it will be recognized that one of the jaws may be a movable jaw configured to move relative to the other jaw between an open and a closed position.

[0139] The instrument 1100 comprises an actuating rod or a cable drive 1410 extending through the shaft 1105 and the wrist assembly 1140 into the jaws 1402, 1404 to open and close the jaws. The cable drive 1410 preferably extends laterally outside the magazine 1120, the drive element 1130, and an inner tube 1430 that passes through the wrist assembly 1140 (see Fig. 42A, which is explained in more detail below). The longitudinal displacement of the cable drive 1410 (i.e., pushing / pulling) causes the jaws 1402, 1404 to open and close. In certain embodiments, the jaws 1402, 1404 can be opened by a distal movement of the cable drive 1410 (and closed by a proximal movement of the cable drive 1410). In other embodiments, the jaws 1402, 1404 can be closed by a distal movement of the cable drive 1410 (and opened by a proximal movement of the cable drive 1410).

[0140] Now, with reference to Fig. 40°C and Fig. 40D, the cable drive 1410 is coupled to a support element 1421, which includes a first and a second slotted pin 1412, 1414 extending laterally outwards from the support element 1421. The slotted pins 1412, 1414 are configured to slide within a first and second curved slot 1416, 1418 in a first and second jaw 1402, 1404, respectively. The slotted pins 1412, 1414 are configured for distal and proximal sliding with movements similar to the cable drive 1410, so that, for example, distal advancement of the cable drive 1410 causes the slotted pins 1412, 1414 to slide to the distal end of the slots 1416, 1418, thereby pivoting the jaws around the pivot pins 1407, 1409 into the open position (see Fig. 40C). Likewise, the proximal retraction of the cable drive 1410 causes the slotted pins 1412, 1414 to slide to the proximal ends of the slots 1416, 1418, thereby pivoting the jaws around the pivot pins 1407, 1409 into the closed position (see Fig. 40D).

[0141] Fig. 41A and Fig. Figure 41B illustrates an alternative embodiment of the jaw assembly 1400A. The jaw assembly 1400A is similar in most respects to the assembly 1400, except that it comprises a first and second actuating rod or cable drive 1410, 1411, which extend laterally outside the magazine 1120, as well as a drive element 1130 and an inner tube 1430 that passes through the wrist assembly 1140 (see Figure 41B). Fig. 42B, explained in more detail below). The cable drive 1411 functions in the same way as the drive 1410. The longitudinal displacement of the cable drive 1411 together with the drive 1410 causes the slotted pins to slide through the slots in the upper and lower jaws 1402, 1404, thus allowing the jaws to pivot between the open and closed positions.

[0142] In certain embodiments, the slots are essentially linear. In other embodiments, the slots may be nonlinear and / or curved. For example, a nonlinear slot may have a curvature from the proximal end to the distal end. The nonlinear slot may be shaped such that a gripping force exerted by the first and / or second jaw is essentially proportional to a force exerted on the pin when the pin is moved from the proximal end to the distal end of the nonlinear slot. In certain embodiments, the nonlinear slot is shaped such that the first and second jaws exert a substantially constant gripping force between them when the pin is moved from the proximal end to the distal end of the slot.This ensures a constant mechanical advantage between the force exerted on the pin and the force exerted by the jaws on the tissue held between them, allowing a user (or a robotic system) to more easily regulate the forces exerted by the jaws on the tissue. Furthermore, this design enables the jaws to exert a substantially constant gripping force regardless of the angle between them. A more detailed description of a nonlinear slot can be found in the jointly assigned U.S. patent application serial number 17 / 081,088, the full disclosure of which is incorporated herein by reference.

[0143] As in Fig. 49B and Fig. As shown in Figure 50B, the first and second jaws 1402, 1404 each comprise guide rails 1440, 1442, which generally extend from a proximal section of the jaws to the distal end 1434, 1436 of each jaw. The guide rails 1440, 1442 are configured to accommodate the hubs 1320, 1322, and 1324 of the clamp 1300, which slide along the guide rails 1440, 1442 as the clamp 1300 is fed distally by the drive element 1130. This ensures that each arm 1302, 1304 of the clamp 1300 is properly fed to each jaw 1402, 1404 (explained in more detail below).

[0144] The jaws 1402 and 1404 can each have an engagement feature at their distal ends to secure the staples after they have been fed in by the drive element 1130. The engagement features allow the drive element 1130 to be released from the staple after the staple has been attached to the jaws 1402 and 1404. Thus, the force required to disengage the retaining tabs 1170, 1172, 1174, and 1716 from the staple is less than the force required to disengage the staple from the engagement features. Furthermore, these engagement features ensure that the staple does not fall out of the jaws 1402 and 1404 before they have been closed and locked onto tissue or a vessel at the target site.

[0145] In one embodiment, these engagement features comprise ramp-shaped leaf springs (not shown) located in or near the guide rails 1440, 1442. These leaf springs are similar in design to the leaf springs 439 described in relation to the jaw assembly 400 and in Fig. Figure 10E above shows the guide rails 1440 and 1442 tapering inwards distally, so that the lateral width decreases distally across the guide rails. As the clamp is advanced distally through the guide rails, it contacts the outer surfaces of the guide rails, which narrow with the distal advance of the clamp. The clamp presses against the leaf springs, pre-tensioning them outwards to allow the clamp to move towards the distal ends of the jaws. This inward spring pressure exerted by the leaf springs holds the clamp firmly within the distal ends of the jaws, preventing it from retracting proximally and / or falling out of the jaws.

[0146] Furthermore, the jaws 1402, 1404 each have distal end sections 1434, 1436, which have a cutout 1454 (see Fig. 52C). The cutouts 1454 are arranged at the distal end of the guide rails 1440, 1442. The cutouts 1454 preferably have a larger cross-sectional area than the guide rails 1440, 1442 and serve to receive the hook 1312 and the locking mechanism 1310 of the clamp 1300. This ensures that the jaws can be opened and removed from the clamp 1300 after the clamp has been closed and locked onto tissue or a vessel.

[0147] It will now be discussed with reference to Fig. 42, Fig. 43A and Fig. 243B describes a wrist assembly 1140. The wrist assembly 1140 can be used within the instrument 100, the instrument 1100, or any other suitable stapler applicator instrument. The wrist assembly 1140 comprises several linkages or discs that allow joint movement of the end effector 1110 and the shaft 1105 in at least two axes perpendicular to the longitudinal axis of the shaft 1105 (i.e., the 'yaw' and 'pitch' axes). As shown, the wrist assembly 1140 comprises a distal linkage or disc 1450 connected to the jaws 1111 and 1112, a proximal linkage or disc 1452 coupled to the shaft 1105, and a middle linkage or disc 1454 between them. In one embodiment, the middle disk 1454 is rotatably coupled to the proximal disk 1452 to allow rotation about one of the axes (see Fig. 41B), and rotatably coupled to the distal disk 1450 for rotation about another of the axes (see Fig. 44A).

[0148] In a preferred embodiment, the distal disc 1450 is attached to the end effector 1110, and the proximal disc 1452 is attached to the shaft 1105. Thus, rotation or joint movement occurs only between the middle disc 1454 and the proximal and distal discs 1450, 1152. This configuration "decouples" the end effector 1110 and the jaws 1111, 1112 from the wrist assembly 1140, so that the end effector 1110 itself does not move in a joint-like manner, which gives the surgeon more control and precision in positioning the jaws 1111, 1112 in a suitable orientation for applying a clamp to tissue or a vessel.

[0149] The actuating rod / cable 1410 (and the rod 1411 in certain embodiments) extends through the wrist assembly 1140, preferably through a flexible sheath 1484 (see Fig. 46), which is anchored to the distal disc 1450 and by internal cutouts in each of the remaining discs 1452 and 1454 (see Fig. 43A) is slidably coupled. The flexible sheath 1484 guides and supports the actuating cable / rod 1410 to transmit a thrust force through the articulated wrist and to the jaws without kinking. Suitable materials for the sheath 1484 include, but are not limited to, laser-cut stainless steel tubes or polymer tubing. The sheath 1484 must be flexible enough to follow the curvature of an articulated wrist and at the same time radially stiff enough to adequately accommodate the actuating cable / rod and its thrust / tension forces. In certain embodiments, the actuating rod 1410 is attached to or anchored to the support element 1421 and slidably coupled by the flexible sheath 1484, which is slidably coupled by the central disk 1454 and the proximal disk 1452.This allows the proximal end of the rod 1410 and the proximal end of the sheath 1484 to slide into and out of the wrist assembly 1140 as the wrist assembly 1140 moves in a joint-like manner. As in . Fig. As shown in Figure 43B, the length of at least one section of the rod 1410 and the sheath 1484 must increase during the joint-like movement of the wrist assembly 1140, since the distance between the shaft 1105 and the end effector 1110 increases (explained in more detail below). By providing a sliding fit between the rod 1410, the sheath 1484, and the middle and proximal disks 1454, 1452, the length of a section of the rod 1410 and the sheath 1484 with the wrist assembly 1140 can increase to accommodate this joint movement.

[0150] With reference to Fig. 44A and Fig. 44B, the inner tube 1430 extends from the shaft 1105 to the end effector 1110 and provides a flexible, smooth channel for the passage of the drive element 1130 and the clamps 1300, even when the wrist assembly 140 moves in a joint-like manner, so that the end effector 1110 and the shaft 1105 are not oriented in a parallel direction (see Fig. 43B). In certain embodiments, the tube 1430 comprises an embedded coil surrounded by and bonded to the coil by an elastic polymer sheath. This provides an overall flexible structure that prevents kinking during tight bends of the wrist assembly 1140. Suitable materials for the polymer sheath include, but are not limited to, durable and highly elastic polymers such as Pebax Shore 35D, Tecoflex Shore 80A, and Pellethane Shore 80A. Suitable materials for the embedded coil include, but are not limited to, stainless steel or Nitinol with a diameter of 0.005 to 0.010.

[0151] The inner tube 1430 is preferably designed with a cross-section that accommodates the one or more actuating rods 1410 and / or 1411. In one embodiment, the tube 1430 has a cross-section with a semicircular section 1460 and a substantially linear section 1462, which provides a substantially D-shaped cross-section (see Fig. 45A). This cross-section allows the actuating rod 1410 to extend laterally outwards along the linear section 1462 from the tube 1430, thereby creating space within the wrist assembly 1140 for the passage of the drive element 1130 and the clamps 1300.

[0152] In a further embodiment, the tube 1430 has a cross-section with a first and a second substantially linear section 1462, 1466 and a first and second semicircular section 1468, 1470, which extend between the linear sections 1462, 1466 (see Fig. 44B). This cross-section allows both actuating rods 1410, 1411 to extend along the linear sections 1462, 1466.

[0153] It will now be discussed with reference to Fig. Figures 46 and 47A-47C describe an embodiment of actuating rods or cable drives 1410, 1411. The one or more actuating rods 1410, 1411 can be used with the instrument 100, the instrument 1100, or any other suitable stapler applicator instrument. As described in Fig. As shown in Figure 47A, the rod 1410 comprises a proximal component 1472, a distal component 1474, and a central flexible component 1476. The flexible component 1476 is designed to bend or move joint-like within the wrist assembly 1140. At least one section of the flexible component 1476 may also be designed to expand or contract longitudinally to accommodate increased or decreased distances between the shaft 1105 and the end effector 1110 when the wrist assembly 1140 moves joint-like.

[0154] In one embodiment, the flexible component 1476 comprises a braided tungsten cable 1478, and the rigid components 1472, 1474 comprise a stainless steel pin or tube. The braided tungsten cable 1478 can be attached to the stainless steel pin or tube by any suitable method, such as crimping, welding, or the like.

[0155] As in Fig. As shown in Figure 47B, the flexible component 1476 can include a flexible PTFE heat shrink tube 1480 that surrounds the cable 1478 to enclose the cable strands when the rod 1410 is under pressure, for example, when the rod 1410 is pressed. The rod 1410 can include a second heat shrink tube 1482 (see Figure 47B). Fig. 47C) which lies above the hose 1480 and extends over a section of the rigid components 1472, 1474 to create a continuous handle cable outer diameter.

[0156] As in Fig. As shown in Figure 46, a flexible sleeve 1484 is provided over the second heat-shrink tubing 1482 to create a sliding fit between the underlying cable 1478 and the sleeve 4182. This allows the rod 1410 within the wrist assembly 1140 to bend and curve and / or contract and expand in length. This also prevents the grip cable from kinking when the rod 1410 is compressed. Suitable materials for the sleeve 1484 include, but are not limited to, laser-cut stainless steel tubing or polymer tubing materials.

[0157] It will now be discussed with reference to Fig. 26A-26C and 49A-53B describe a procedure for applying multiple staples to tissue or vessels in a patient. As in Fig. As shown in Figure 26B, the drive element 1130 is first retracted proximally, causing the retaining tabs 1174, 1176 to bend outwards and slide over the top and bottom surfaces 1136, 1138 of the staple magazine housing 1134. This allows the retaining tabs 1170, 1172 to spring inwards to grip and secure the staple 1300. Simultaneously, the feed tabs 1182 spring inwards to contact and engage a proximal surface of the proximal staples (see Figure 26B). Fig. 26C).

[0158] The drive element 1130 is then advanced distally until the distal component 1164 moves beyond the distal end of the magazine housing 1134. During this process, the most distal clamp 1300A is advanced forward with the retaining tabs 1170, 1172, and the proximal clamps 1300B, 1300C, etc., are advanced with the advance tabs 1182. As soon as the distal component 1164 moves distal to the magazine housing 1134, the retaining tabs 1174, 1176 spring downwards and upwards to engage the top and bottom surfaces of the clamp 1300A (see Fig. 48B).

[0159] As in Fig. As shown in Figure 49B, the drive element 1130 is then advanced distally to advance the distal clamp 1300A into the end effector 1110. The drive element 1130 and the clamp 1300A pass through the inner tube 1430 as they pass through the wrist assembly 1140. As previously explained, the inner tube 1430 can bend and flex, forming a smooth passage for the drive element 1130 and the clamp 1300A, even when the end effector 1110 is moved in a pivot-like manner relative to the shaft 1105 (see Figure 49B). Fig. 49C and D).

[0160] In a preferred embodiment, the clamp 1300A is oriented at an angle of about 30 to 60 degrees, preferably about 45 degrees, relative to a plane passing through the shaft 1105 or the wrist axis (see Fig. 55A-55C). This angle ensures less contact between the clamp 1300A and the inner surface of the tube 1430 when the wrist assembly 1140 is moved in a hinge-like manner than if, for example, the clamp 1300A were oriented at an orthogonal angle to the wrist axis (see, for example, Fig. 54A-54C). By reducing the contact between the clamp and the tube 1430, the amount of force required to push the clamp through the wrist assembly into the jaws is reduced.

[0161] When the distal staple 1300A is moved into the jaws 1402, 1404, the feed tabs 1182 push the more proximal staples (1300B, 1300C, etc.) distally into the next distal position within the staple magazine 1120. These staples are then in the position to engage with the retaining tabs 1170, 1172 after the distal staple 1300A has been released and the drive element 1130 has been retracted to its original position (see Fig. 26B).

[0162] Now, with reference to Fig. 50A and Fig. 50B, the drive element 1130 pushes the clamp 1300 into the jaws 1402, 1404, so that the hubs 1320, 1322 and 1324 of the latch 1310 and the hook 1312 slide through the guide rails 1440, 1442. This ensures that the arms 1302, 1304 of the clamp 1300 open and move forward to the distal end of the jaws 1402, 1404, thereby placing the clamp 1300 in a position where it can be closed and latched by the jaws 1402, 1404 (see Fig. 52A-52C). As the arms 1302, 1304 of the clamp 1300 slide through the guide rails 1440, 1442, they engage in the ramp-shaped leaf springs at the distal ends of the jaws 1402, 1404. These leaf springs secure the arms 1302, 1304 of the clamp 1300 to the jaws.

[0163] After the clamp has been fed to the jaws, the drive element 1130 can be detached from the clamp 1300 and retracted proximally back into the shaft 1105 in order to remove another clamp 1300B (see Fig. 51 and Fig. 352B). In some embodiments, the drive element 1130 is retracted when the jaws are open. In other embodiments, the drive element 1130 can be retracted after the jaws have been closed.

[0164] The surgical instruments described herein can be coupled to a proximal control system that monitors and controls the linkages or discs in the wrist assembly to move the end effector 110 and the jaws joint-like relative to the shaft 105 and to move the drive element 130 distally and proximally to feed staples to the jaws. Furthermore, the control system can monitor and control the longitudinal position of the drive element 130 relative to each of the staples within the magazine 120. In particular, the control system can monitor the position of the distal engagement elements of the drive element along the magazine 120 to determine when the drive element should be moved distally or proximally.

[0165] For example, the control system can monitor and control the drive element to move these engagement elements proximally until they are positioned over the openings in the upper and lower magazine housings associated with the first most distal clamp in the magazine. The control system can then monitor and control the drive element 130 to move the engagement elements distally until the most distal clamp is located at the desired position within the jaws 402, 404. The control system can monitor and control the proximal retraction of the drive element 130 after the clamp has been locked and secured to tissue and / or a vessel to prevent unintentional disengagement of the drive element and clamp before this occurs. The control system can also monitor and control the movement of the drive element to a position in the magazine associated with the most distal clamp remaining in the magazine.

[0166] This control system can be a manual system with user interfaces that allow the user to control each of the instrument's functions, or it can be an automatic system that monitors and controls these functions. In some embodiments, the control system is a combination of manual and automatic control, allowing the user to adjust or control certain functions, while these functions are automatically limited to specific ranges or parameters.

[0167] In certain embodiments, the instrument may include sensors (not shown) for detecting a location of the manipulation elements. The sensors may include any suitable sensors for detecting location, force, and / or torque. In one embodiment, the sensors include fiber-optic bending sensors, such as fiber Bragg gratings (FBGs), to provide strain measurements in the jaws, tension bands, and / or other components of the surgical instrument. Various systems and methods for monitoring the shape and relative position of an optical fiber in three dimensions are described in U.S. Patent Publication No. 2006 / 0013523, filed on July 13, 2005, and in U.S. Patent No. 6,389,187, filed on June 17, 1998, the complete disclosures of which are hereby incorporated by reference for all purposes.

[0168] The control system can include one or more processors (e.g., microprocessor, microchip, or application-specific integrated circuit), one or more memory devices (e.g., random-access memory and / or read-only memory), and an I / O interface and / or a communication interface. The processors can include one or more computer-readable memory devices and / or software applications that store program instructions enabling the processor(s) to compare the detected torque or force with a predefined range. The I / O devices can include one or more devices that allow the user to interact with the system (e.g., a user interface). Examples of I / O devices include a touchscreen display, a keypad, one or more selector switches, and one or more indicators.

[0169] Although described as processors, it should be understood that in practice, these controllers can be implemented by any combination of hardware, software, and firmware. Furthermore, their functions described herein can be performed by a single unit or distributed across various components, each of which can, in turn, be implemented by any combination of hardware, software, and firmware.

[0170] With reference to Fig. Figure 56 shows an exemplary embodiment of a telemanipulated surgical instrument 500 that can support a previously described instrument. As shown, the instrument 500 generally includes a proximal housing 510 at its proximal end, which is coupled to the shaft 520 of the instrument. The proximal housing 510 may include an instrument working memory or storage device (not shown). The working memory can perform a number of functions when the instrument is loaded onto a manipulator arm (not shown) of a robot-assisted control system. For example, the working memory may provide a signal that verifies that the instrument is compatible with that particular surgical system.Additionally, the memory can identify the instrument and end effector type (whether it's a scalpel, needle forceps, jaws, scissors, a staple applicator, an electrocautery blade, or the like) for the surgical system, allowing the system to reconfigure its programming to take full advantage of the instrument's specific capabilities. As explained in more detail below, the memory can contain details about the instrument's architecture and include specific values ​​that should be used in control algorithms, such as tool conformance and gain values.

[0171] The proximal housing 510 may also include a force / torque drive transmission mechanism (not shown) for receiving power from the manipulator arm motors. The force / torque drive transmission mechanism transfers the power from the motors to an end effector 530 of the instrument via an instrument shaft 520 mounted on the transmission mechanism. Examples of surgical robot instruments, instrument / manipulator arm interface structures, and data transmission between the instruments and the servomechanism are described in more detail in U.S. Patent No. 6,331,181, the complete disclosure of which is hereby incorporated by reference.

[0172] Fig. Figure 59 shows a flowchart of a process 800 controlled by a control system, for example a robot-assisted control system (such as the one in Fig. 57 and Fig. 58 shown and described below), which is coupled to a proximal housing or a backend mechanism 510 of the surgical instrument. The robotic control system comprises at least one processor that relays input commands from user-operated main controls to the first and second actuation systems within the backend mechanism. The actuation systems then provide the mechanical actuation and control of the instrument to perform various functions, such as joint movement and the application of clamps in response to manipulation of the main input devices.

[0173] In one embodiment, the backend mechanism comprises a first drive system for controlling the articulated movement of the end effector relative to the shaft and a second drive system for controlling the longitudinal displacement of the drive element along the shaft to advance clamps into the jaws and retract the drive element after the clamps have been coupled to the jaws and / or closed and sealed to a vessel. The backend mechanism may include a third drive system for opening and closing the jaws and / or a fourth drive or control system for monitoring and controlling the longitudinal position of the drive element (i.e., the clamp advancer) within the instrument shaft.

[0174] In one embodiment of method 800, the control system can be operated to actuate the first drive system in the backend mechanism 510 to move the end effector in a joint-like manner, e.g., to extend a bent wrist so that the end effector is substantially parallel to the shaft (see step 802). Once the wrist is extended, the control system can be operated to actuate the second drive system in the backend mechanism to advance the drive element distally to advance a first or most distal clamp into the jaws of the instrument (see step 804). In some embodiments, the jaws are opened before the clamp is advanced into the jaws. In other embodiments, the jaws may be closed or partially open.Once the clamp is coupled to the jaws (step 806), the control system can be operated to actuate the second drive system and retract the drive element proximally from the jaws so that it is aligned with a second (or the next most distal) clamp in the clamp magazine (see step 808). In some embodiments, the clamps are advanced together, so that the second clamp is advanced into the position previously occupied by the first clamp when the first clamp is advanced into the jaws. In these embodiments, the drive element is retracted to the same position relative to the instrument or clamp magazine to engage the second clamp as the first clamp.In other embodiments, the drive element can be retracted further proximally to engage the second clamp (if the second clamp was not advanced distally in the same operation as the first clamp). In these embodiments, the control system may include sensors, controllers, or other mechanisms for determining the position of the clamp advancer to ensure that it is retracted to a position corresponding to the second clamp in the magazine (as previously explained). It should be noted that any of the drive systems described above can be independent or combined, so that, for example, one drive system may power two functions, such as the rotation of the end effector and the clamping of the jaws.

[0175] The control system can then be operated to actuate the first drive system to move the end effector in a hinged manner to rotate the jaws relative to the shaft, for example, to position the jaws around a target vessel or tissue (step 810). The control system can then be operated to actuate the third drive system to close the jaws so that the clamp is closed, locked, and sealed around the target vessel or tissue (step 812).

[0176] It will be readily apparent that the drive element and clamps can be advanced through the wrist toward the end effector (and the drive element retracted) while the wrist is flexed (i.e., while the end effector is being rotated in the yaw, pitch, or roll direction). As explained above, the drive elements described herein include flexible sections that curve or bend within the wrist of the instrument so that the drive element can remain in position within the wrist and jaws during the articulating movement of the end effector. Thus, in certain embodiments, the control system can be operated such that the end effector is first moved in an articulating manner so that the jaws are positioned around the target tissue or vessel, and then the drive element and first clamp are advanced into the jaws.

[0177] As mentioned above, the available surgical instruments can be used in a robot-assisted telemanipulated surgical system. Fig. Figure 57 illustrates, as an example, a top view of an operating room in which a robot-assisted surgical system is used. The robot-assisted surgical system in this case is a Robot-Assisted Surgical System 600 with a console (“C”) used by a surgeon (“S”) while performing a minimally invasive diagnostic or surgical procedure, usually with the assistance of one or more assistants (“A”), on a patient (“P”) lying on an operating table (“O”).

[0178] The servomechanism used for telemedicine often accepts input from two main controllers (one for each of the surgeon's hands) and can include two or more robotic arms. A surgical instrument is mounted on each of the robotic arms. Operational communication between the main controllers and the associated robotic arm and instrument assemblies is typically handled by a control system. This control system usually includes at least one processor that relays input commands from the main controllers to the associated robotic arm and instrument assemblies and returns them in cases such as force feedback. An example of a robot-assisted surgical system is the DA VINCI™ system marketed by Intuitive Surgical, Inc. of Sunnyvale, California.

[0179] A number of different structural arrangements have been used to support the surgical instrument at the surgical site during robotic surgery. The driven linkage or “slave” is often referred to as a robot-assisted surgical manipulator, and exemplary linkage assemblies for use as a robot-assisted surgical manipulator during minimally invasive robotic surgery are described in U.S. Patents 7,594,912, 6,758,843, 6,246,200, and 5,800,423, the complete disclosures of which are incorporated herein by reference in their entirety for all purposes. These linkages often manipulate an instrument holder to which an instrument with a shaft is mounted.Such a manipulator structure can include a parallelogram joint that generates a movement of the instrument holder constrained to a rotation about a pitch axis intersecting a remote manipulation center located along the length of the instrument shaft. Such a manipulator structure can also include a yaw joint that generates a movement of the instrument holder constrained to a rotation about a yaw axis perpendicular to the pitch axis, also intersecting the remote manipulation center. By aligning the remote manipulation center with the intersection point toward the inner operating site (e.g.,(with a trocar or cannula inserted into the abdominal wall during laparoscopic surgery) an end effector of the surgical instrument can be safely positioned by moving the proximal end of the shaft using the manipulator linkage, without exerting potentially dangerous forces on the abdominal wall. Alternative manipulator structures are described, for example, in U.S. Patents Nos. 6,702,805, 6,676,669, 5,855,583, 5,808,665, 5,445,166, and 5,184,601, the complete disclosures of which are incorporated herein by reference in their entirety for all purposes.

[0180] During the surgical procedure, the telesurgical system can enable the mechanical actuation and control of a variety of surgical instruments or tools with end effectors that perform different functions for the surgeon, such as holding or driving a needle, grasping a blood vessel, dissecting tissue, or the like, in response to manipulation of the master input devices. The manipulation and control of these end effectors is a particularly advantageous aspect of robot-assisted surgical systems. For this reason, it is desirable to provide surgical tools that incorporate mechanisms allowing two or three degrees of rotational movement of an end effector to mimic the natural action of a surgeon's wrist.Such mechanisms should be appropriately sized for use in minimally invasive procedures and have a relatively simple design to reduce potential sources of error. Furthermore, they should offer a sufficient range of motion to allow manipulation of the end effector in a wide variety of positions.

[0181] The console comprises a monitor 604 for displaying an image of the surgical site to the surgeon, left and right manipulable control devices 608 and 609, a foot pedal 605, and a processor 602. The control devices 608 and 609 can include one or more of a variety of different input devices, such as joysticks, gloves, trigger guns, hand-operated controls, or the like. The processor 602 can be a dedicated computer, which may be integrated into the console or positioned next to it.

[0182] The surgeon performs a minimally invasive surgical procedure by operating the control devices 608 and 609 (hereinafter also referred to as "main manipulators") such that the processor 602 causes the respective associated robot arm assemblies 628 and 629 (hereinafter also referred to as "slave manipulators") to manipulate their respective detachably coupled surgical instruments 638 and 639 (hereinafter also referred to as "tools") accordingly, while the surgeon views the surgical site in 3D on the console monitor 604 as captured by a stereoscopic endoscope 640.

[0183] Each of the tools 638 and 639, as well as the endoscope 640, can be inserted into the patient through a cannula or other tool guide (not shown) to extend to the surgical site through a suitable minimally invasive incision, such as the incision 666. Each of the robot arms is conventionally formed from connecting elements, such as the connecting element 662, which are coupled to one another and moved via motor-controlled or active joints, such as the joint 663.

[0184] The number of surgical instruments used simultaneously, and consequently the number of robotic arms used in the System 600, generally depends, among other factors, on the diagnostic or surgical procedure and the space limitations in the operating room. If it is necessary to change one or more of the instruments used during a procedure, the assistant can remove the unused instrument from their robotic arm and replace it with another instrument 331 from a tray (“T”) in the operating room.

[0185] The monitor 604 can be positioned near the surgeon's hands so that it displays a projected image oriented in such a way that the surgeon feels as if he is actually looking directly down at the surgical site. For this purpose, the images of instruments 638 and 639 can be made to appear as if they were located essentially where the surgeon's hands are.

[0186] The processor 602 performs various functions within the system 600. One function it performs is to transmit the mechanical movement of the control devices 608 and 609 via control signals over the bus 610 to their respective robot arms 628 and 629, enabling the surgeon to effectively manipulate their respective instruments 638 and 639. Another important function is to implement various control system processes described herein.

[0187] Robot-assisted surgical systems and procedures are described in U.S. Patent No. 5,797,900, filed May 16, 1997, granted August 25, 1998; U.S. Patent No. 6,132,368, filed November 21, 1997, granted October 17, 2000; U.S. Patent No. 6,331,181, filed October 15, 1999, granted December 18, 2001; U.S. Patent No. 6,441,577, filed April 3, 2001, granted August 27, 2002; U.S. Patent No. 6,902,560, filed January 6, 2004, granted June 7, 2005; and U.S. Patent No. 6,936,042. Filed on April 16, 2002, granted on August 30, 2005, and U.S. Patent No. 6,994,703, filed on December 4, 2002, granted on February 7, 2006, are further described, the complete disclosures of which are incorporated herein by reference for all purposes. A currently used suitable robot-assisted surgical system is the da Vinci S Surgical System by Intuitive Surgical, Inc.

[0188] Fig.Figure 58 illustrates, as an example, a side view of a simplified (not necessarily to scale or complete) illustrative robot arm assembly 700 (which is representative of robot arm assemblies 628 and 629) holding a surgical instrument 750 (which is representative of tools 638 and 639) for performing a surgical procedure. The surgical instrument 750 is detachably held in a tool holder 740. The arm assembly 700 is mechanically supported by a base 701, which may be part of a patient-side movable cart or attached to the operating table or ceiling. It includes connecting links 702 and 703, which are coupled to each other and to the base 701 via adjusting joints 704 and 705.

[0189] The adjusting joints 704 and 705 in this example are passive joints that allow manual positioning of the arm 700 when their brakes are released. For example, the adjusting joint 704 allows manual rotation of the connecting link 702 about the axis 706, and the adjusting joint 705 allows manual rotation of the connecting link 703 about the axis 707.

[0190] Although only two connecting links and two adjusting joints are shown in this example, more or fewer of these can be used in this and other robot arm assemblies described herein, as required. For example, while adjusting joints 704 and 705 are useful for the horizontal positioning of the arm 700, additional adjusting joints can be provided for limited vertical and angular positioning of the arm 700. However, for significant vertical positioning of the arm 700, the arm 700 can also be moved along the vertical axis of the base 701 and locked in position.

[0191] The robot arm assembly 700 also includes three motor-driven active joints. A yaw joint 710 allows the arm section 730 to rotate about an axis 761, and a pitch joint 720 allows the arm section 730 to rotate about an axis perpendicular to the axis 761 and orthogonal to the plane of the drawing. The arm section 730 is configured such that sections 731 and 732 are always parallel to each other when the pitch joint 720 is rotated by its motor. Consequently, the instrument 770 can be controlled by driving the yaw and pitch motors to pivot about the pivot point 762, which is generally determined by manually positioning the adjustment joints 704 and 705 so that it is located at the incision point in the patient. Additionally, an insertion gear 745 can be coupled with a linear drive mechanism (not shown) to extend or retract the instrument 750 along its axis 763.

[0192] Although each of the yaw, pitch and insertion joints or gears 710, 720 and 745 is controlled by an individual joint or gear control, the three controls are controlled by a common master / slave control system, so that the robot arm assembly 700 (also referred to here as the "slave manipulator") can be controlled by manipulation of the associated master manipulator by the user (e.g. the surgeon).

[0193] While several embodiments are shown in the drawings, the description is not intended to be limited to them, as it is meant to be as broad as the prior art permits, and the specification should be read accordingly. Therefore, the above description should not be understood as limiting, but merely as an example of currently disclosed embodiments. Consequently, the scope of the embodiments should be determined by the attached claims and their legal equivalents, and not by the examples given.

[0194] Furthermore, the terminology used in this description is not intended to limit the devices described herein. The term "force" is to be understood as encompassing both force and torque, unless otherwise specified herein or clearly contradicted by the context. The terms "tools" and "instruments" are used interchangeably here to refer to the surgical instruments. As used in this description and the appended claims, the singular forms "a," "an," and "the," as well as any singular use of a word, also include plural references unless expressly and unambiguously limited to one reference. The terms "comprising," "having," "including," and "containing" are to be understood as open terms (i.e., in the sense of "including but not limited to"), unless otherwise specified.The terms “connected” and “coupled” are to be understood as meaning that they are wholly or partially contained in something, attached to something, or joined together, even if something lies in between.

[0195] Spatially relative terms—such as “proximal” and “distal”—can be used to describe the relationship of one element or feature to another, as illustrated in the figures. These spatially relative terms are intended to encompass various positions (i.e., locations) and orientations (i.e., rotational placements) of a device during use or operation, in addition to the position and orientation shown in the figures. For example, the terms “proximal” and “distal” are relative terms, with the term “distal” referring to the portion of the object that is furthest from the operator of the instrument and closest to the site of operation, such as the opening of the tool cover or the end effector of the instrument.The term "proximal" indicates the relative proximity to the operator of the surgical instrument and refers to the section of the object that is closest to the operator and furthest from the surgical site. In the present application, an end effector refers to a tool installed at the distal end of an instrument, including, but not limited to, forceps or graspers, needle drivers, scalpels, scissors, spatulas, blades, and other tools that may or may not use energy to cauterize tissue (i.e., a monopolar or bipolar tool).

[0196] The person skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. The features illustrated or described in connection with an exemplary embodiment can be combined with the features of other embodiments. The person skilled in the art can develop various alternatives and modifications without departing from the disclosure. Accordingly, the present description is intended to encompass all such alternatives, modifications, and variants. Likewise, the person skilled in the art will recognize further features and advantages of the present disclosure based on the embodiments described above. Accordingly, the present description is not limited to what has been shown and described in particular, except as specified in the accompanying claims.

[0197] For example, in a first aspect, a first embodiment is a surgical instrument for applying surgical staples to tissue. The instrument comprises an elongated shaft with a longitudinal axis, an end effector coupled to the shaft comprising a first and a second jaw movable between an open and a closed position, a drive element configured for longitudinal displacement through the shaft to deliver one or more surgical staples to the first and second jaw, and an actuator extending through the shaft laterally to the drive element relative to the longitudinal axis and configured to move the jaws between the open and the closed position.

[0198] A second embodiment is the first embodiment, wherein the longitudinal displacement of the actuator causes the jaws to move between the open and closed positions.

[0199] A third embodiment is any combination of the first two embodiments, which additionally includes a second actuator laterally to the drive element relative to the longitudinal axis, wherein the longitudinal displacement of the first and second actuators causes the jaws to move between the open and closed positions.

[0200] A fourth embodiment is any combination of the first three embodiments, wherein the actuator comprises an elongated rod with a distal end section and a slotted pin coupled to the distal end section, wherein the end effector comprises a slot and wherein the slotted pin advances through the slot to move the jaws between the open and closed positions.

[0201] A fifth embodiment is any combination of the first four embodiments, wherein the actuator comprises an elongated rod with a distal end section and a first and second slot pin coupled to the distal end section, wherein the end effector comprises a first slot coupled to the first jaw and a second slot coupled to the second jaw, wherein the first and second slot pins advance through the first and second slots respectively to move the jaws between the open and closed positions.

[0202] A sixth embodiment is any combination of the first five embodiments, further comprising: a wrist assembly coupling the end effector to the shaft; and an inner tube extending through the wrist assembly, the drive element being configured to move through the inner channel.

[0203] A seventh embodiment is any combination of the first six embodiments, wherein the actuator is arranged laterally to the inner tube.

[0204] An eighth embodiment is any combination of the first seven embodiments, wherein the wrist assembly couples the end effector to the shaft in a pivotable manner about an axis perpendicular to a shaft axis.

[0205] A ninth embodiment is any combination of the first eight embodiments, wherein the actuator comprises a handle cable with a flexible section arranged within the wrist assembly and configured to bend when the wrist assembly moves in a joint-like manner.

[0206] A tenth embodiment is any combination of the first nine embodiments, wherein the wrist assembly comprises distal and proximal connecting links, and wherein the handle cable comprises an outer sheath which is slidably coupled to at least one of the distal and proximal connecting links.

[0207] An eleventh embodiment is any combination of the first ten embodiments, wherein the outer sheath of the handle cable is slidably coupled to the proximal connecting element and attached to the distal connecting element.

[0208] A twelfth embodiment is any combination of the first eleven embodiments, wherein the wrist assembly connects the end effector pivotably to the shaft about a first and a second axis, the first and second axes being perpendicular to the shaft axis.

[0209] A 13th embodiment is any combination of the first 12 embodiments, wherein the wrist assembly comprises a proximal connecting element, a distal connecting element and a middle connecting element arranged between the proximal and the distal connecting element, wherein the grip cable comprises an outer sheath which is slidably coupled to the proximal connecting element and the middle connecting element and is attached to the distal connecting element.

[0210] A 14th embodiment is any combination of the first 13 embodiments, wherein the handle cable further comprises proximal and distal sections on both sides of the flexible section, the proximal and distal sections having a greater stiffness than the flexible section.

[0211] A 15th embodiment is any combination of the first 14 embodiments, wherein the drive element comprises a distal component for detachable coupling with a surgical clamp.

[0212] A 16th embodiment is any combination of the first 15 embodiments, wherein the actuator comprises a proximal end section configured for coupling with a robot-assisted control system for moving the actuator to open and close the jaws.

[0213] In another aspect, a first embodiment is a surgical instrument for applying surgical staples to tissue. The instrument comprises an elongated shaft with a longitudinal axis, a wrist assembly coupled to a distal end section of the shaft, a flexible tube extending through the wrist and defining an inner channel, an end effector rotatably coupled to the wrist and comprising a first and second jaw movable between an open and a closed position, and a drive element configured for longitudinal displacement through the inner channel of the flexible tube to deliver one or more surgical staples to the first and second jaw.

[0214] A second embodiment is the first embodiment, wherein the flexible hose is configured to bend when the wrist assembly moves in a joint-like manner relative to the end effector.

[0215] A third embodiment is any combination of the first two embodiments, wherein the wrist assembly is pivotably coupled to the end effector about a first and a second axis, the first and the second axis being perpendicular to the shaft axis.

[0216] A fourth embodiment is any combination of the first three embodiments, wherein the flexible hose is configured to bend at least one first and one second point of the flexible hose when the wrist assembly pivots about the first and second axes.

[0217] A fifth embodiment is any combination of the first four embodiments, wherein the flexible hose comprises a coil and an elastic polymer sheath surrounding the coil.

[0218] A sixth embodiment is any combination of the first five embodiments, wherein the flexible hose has a smooth inner surface.

[0219] A seventh embodiment is any combination of the first six embodiments, wherein the flexible hose has a substantially D-shaped cross-section.

[0220] An eighth embodiment is any combination of the first seven embodiments, wherein the D-shaped cross-section of the flexible tube comprises a semicircular section and a substantially linear section, wherein the surgical instrument further comprises an actuating rod extending laterally from the shaft to the end effector to the substantially linear section of the flexible tube, the actuating rod being configured to move the jaws between the open and closed positions.

[0221] A 9th embodiment is any combination of the first eight embodiments, wherein the flexible hose has a cross-section with a first and a second substantially linear section and a first and a second semicircular section extending between the linear sections.

[0222] A tenth embodiment is any combination of the first nine embodiments, further comprising a first and second actuating rod extending from the shaft to the end effector and configured to move the jaws between the open and closed positions, the first and second rod being lateral to the first and second substantially linear sections of the flexible hose, respectively.

[0223] An eleventh embodiment is any combination of the first ten embodiments, further comprising an actuator coupled to the wrist assembly for rotating the end effector relative to the shaft, wherein the actuator is configured for coupling with a robot-assisted control system.

[0224] In another aspect, a first embodiment is a surgical instrument for applying surgical staples to tissue. The instrument comprises an elongated shaft with a longitudinal axis, an end effector with a first and second jaw movable between an open and a closed position, a wrist assembly with a first connecting element coupled to the end effector and rotatably coupling the end effector to the shaft about an axis perpendicular to the shaft, and a drive element configured for longitudinal displacement through the wrist assembly to deliver one or more surgical staples to the first and second jaw.

[0225] A second embodiment is the first embodiment, wherein the wrist assembly further comprises a second connecting element rotatably coupled to the first connecting element.

[0226] A third embodiment is any combination of the first two embodiments, wherein the wrist assembly further comprises a middle connecting element between the first and second connecting elements, wherein the middle connecting element is rotatable with the first and second connecting elements about a second axis perpendicular to the first axis and coupled perpendicular to the shaft.

[0227] A fourth embodiment is any combination of the first three embodiments, wherein the second connecting element is rigidly attached to the end effector.

[0228] A fifth embodiment is any combination of the first four embodiments, further comprising an actuator extending laterally to the drive element through the wrist assembly and configured to move the jaws between the open and closed positions.

[0229] A sixth embodiment is any combination of the first five embodiments, wherein the actuator comprises a rod with a flexible section extending through the wrist assembly.

[0230] A seventh embodiment is any combination of the first six embodiments, wherein the flexible section is configured to expand and contract along a longitudinal axis of the flexible section as the distal connecting element moves joint-like relative to the proximal connecting element.

[0231] An eighth embodiment is any combination of the first seven embodiments, wherein the flexible section comprises an outer sheath which is attached to the distal connecting element and slidably coupled to the proximal connecting element.

[0232] A 9th embodiment is any combination of the first eight embodiments, wherein the drive element comprises a distal component for detachable coupling with a surgical clamp.

[0233] A 10th embodiment is any combination of the first nine embodiments, wherein the first and second jaws each comprise a first and second guide rail for receiving projections on the surgical clamp in order to guide the surgical clamp to the jaws.

[0234] An eleventh embodiment is any combination of the first ten embodiments, wherein the surgical clamp comprises a first and a second arm, and wherein the first and / or the second jaw comprises an engagement element for attaching the first and / or the second arm of the clamp to said first and / or second jaw. QUOTES INCLUDED IN THE DESCRIPTION

[0000] This list of documents cited by the applicant was automatically generated and is included solely for the reader's convenience. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions. Cited patent literature

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[0051] US 2019 / 107646

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[0051] WO 2020 / 025655

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[0056] WO 2015 / 127250A1

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[0142] US 2006 / 0013523

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[0179] US 5,797,900

[0187] US 6,132,368

[0187] US 6,441,577

[0187] US 6,902,560

[0187] US 6,936,042

[0187] US 6,994,703

[0187]

Claims

[1] Surgical instrument for applying surgical staples to tissue, the instrument comprising: an elongated wave with a longitudinal axis; an end effector coupled to the shaft and comprising a first and a second jaw that are movable between an open and a closed position; a drive element configured for longitudinal displacement through the shaft to deliver one or more surgical clamps to the first and second jaw; and an actuator that extends laterally to the drive element relative to the longitudinal axis through the shaft and is configured to move the jaws between the open and closed positions. [2] Instrument according to claim 1, wherein the longitudinal displacement of the actuator causes the jaws to move between the open and closed positions. [3] Instrument according to claim 1, further comprising a second actuator lateral to the drive element relative to the longitudinal axis, wherein the longitudinal displacement of the first and second actuator causes the jaws to move between the open and closed positions. [4] Instrument according to claim 1, wherein the actuator comprises an elongated rod with a distal end section and a slotted pin coupled to the distal end section, wherein the end effector comprises a slot and wherein the slotted pin advances through the slot to move the jaws between the open and closed positions. [5] Instrument according to claim 1, wherein the actuator comprises an elongated rod with a distal end section and a first and a second slotted pin coupled to the distal end section, wherein the end effector comprises a first slot coupled to the first jaw and a second slot coupled to the second jaw, wherein the first and the second slotted pins each advance through the first and the second slots to move the jaws between the open and the closed position. [6] Instrument according to claim 1, further comprising: a wrist assembly that couples the end effector to the shaft; and an inner tube extending through the wrist assembly, with the drive element configured to move through the inner channel. [7] Instrument according to claim 6, wherein the actuator is arranged laterally to the inner tube. [8] Instrument according to claim 6, wherein the wrist assembly couples the end effector pivotably to the shaft about an axis perpendicular to a shaft axis. [9] Instrument according to claim 8, wherein the actuator comprises a handle cable having a flexible section arranged within the wrist assembly and configured to bend when the wrist assembly moves in a joint-like manner. [10] Instrument according to claim 9, wherein the wrist assembly comprises distal and proximal connecting elements, wherein the handle cable comprises an outer sheath which is slidably coupled to at least one of the distal and proximal connecting elements. [11] Instrument according to claim 10, wherein the outer sheath of the handle cable is slidably connected to the proximal connecting element and is attached to the distal connecting element. [12] Instrument according to claim 6, wherein the wrist assembly couples the end effector pivotably to the shaft about a first and a second axis, wherein the first and the second axis are perpendicular to the shaft axis. [13] Instrument according to claim 12, wherein the wrist assembly comprises a proximal connecting element, a distal connecting element and a middle connecting element arranged between the proximal and the distal connecting element, wherein the handle cable comprises an outer sheath which is slidably coupled to the proximal connecting element and the middle connecting element and is attached to the distal connecting element. [14] Instrument according to claim 9, wherein the handle cable further comprises proximal and distal sections on both sides of the flexible section, the proximal and distal sections having a higher stiffness than the flexible section. [15] Instrument according to claim 1, wherein the drive element comprises a distal component for detachable coupling with a surgical clamp. [16] Instrument according to claim 1, wherein the actuator comprises a proximal end section configured for coupling with a robot-assisted control system for moving the actuator to open and close the jaws. [17] Surgical instrument for applying surgical staples to tissue, the instrument comprising: an elongated wave with a longitudinal axis; a wrist assembly coupled to a distal end section of the shaft; a flexible tube that extends through the wrist and defines an internal channel; an end effector rotatably coupled to the wrist and comprising a first and a second jaw that are movable between an open and a closed position; and a drive element configured for longitudinal movement through the inner channel of the flexible tube to deliver one or more surgical clamps to the first and second jaw. [18] Surgical instrument according to claim 17, wherein the flexible tube is configured to bend when the wrist assembly moves joint-like relative to the end effector. [19] Surgical instrument according to claim 17, wherein the wrist assembly is pivotably coupled to the end effector about a first and second axis, the first and second axis being perpendicular to the shaft axis. [20] Surgical instrument according to claim 19, wherein the flexible tube is configured to bend at at least a first and a second location on the flexible tube when the wrist assembly rotates about the first and second axes. [21] Surgical instrument according to claim 17, wherein the flexible tube comprises a coil and an elastic polymer sheath surrounding the coil. [22] Surgical instrument according to claim 17, wherein the flexible tube has a smooth inner surface. [23] Surgical instrument according to claim 17, wherein the flexible tube has a substantially D-shaped cross-section. [24] Surgical instrument according to claim 23, wherein the D-shaped cross-section of the flexible tube comprises a semicircular section and a substantially linear section, wherein the surgical instrument further comprises an actuating rod extending from the shaft to the end effector laterally to the substantially linear section of the flexible tube, wherein the actuating rod is configured to move the jaws between the open and closed positions. [25] Surgical instrument according to claim 17, wherein the flexible tube has a cross-section with a first and a second substantially linear section and a first and a second semicircular section extending between the linear sections. [26] Surgical instrument according to claim 25, further comprising a first and a second actuating rod extending from the shaft to the end effector and configured to move the jaws between the open and closed positions, wherein the first and second rods are arranged laterally to the first and second substantially linear sections of the flexible tube, respectively. [27] Instrument according to claim 17, further comprising an actuator coupled to the wrist assembly for rotating the end effector relative to the shaft, wherein the actuator is configured for coupling with a robot-assisted control system. [28] Surgical instrument for applying surgical staples to tissue, the instrument comprising: an elongated wave with a longitudinal axis; an end effector with a first and a second jaw that are movable between an open and a closed position; a wrist assembly comprising a first connecting link coupled to the end effector and rotatably connecting the end effector to the shaft about an axis perpendicular to the shaft; and a drive element configured for longitudinal movement through the wrist assembly to deliver one or more surgical clamps to the first and second jaw. [29] Surgical instrument according to claim 28, wherein the wrist assembly further comprises a second connecting element rotatably coupled to the first connecting element. [30] Surgical instrument according to claim 29, wherein the wrist assembly further comprises a middle connecting element between the first and second connecting element, wherein the middle connecting element is rotatably coupled to the first and second connecting element about a second axis perpendicular to the first axis and perpendicular to the shaft. [31] Surgical instrument according to claim 29, wherein the second connecting element is rigidly attached to the end effector. [32] Surgical instrument according to claim 28, further comprising an actuator extending laterally to the drive element through the wrist assembly and configured to move the jaws between the open and closed positions. [33] Surgical instrument according to claim 32, wherein the actuator comprises a rod with a flexible section extending through the wrist assembly. [34] Surgical instrument according to claim 33, wherein the flexible section is configured to expand and contract along a longitudinal axis of the flexible section when the distal connecting element moves joint-like relative to the proximal connecting element. [35] Surgical instrument according to claim 33, wherein the flexible section comprises an outer sheath which is attached to the distal connecting element and slidably coupled to the proximal connecting element. [36] Surgical instrument according to claim 28, wherein the drive element comprises a distal component for detachable coupling with a surgical clamp. [37] Surgical instrument according to claim 36, wherein the first and second jaws each comprise a first and second guide rail for receiving projections on the surgical clamp in order to guide the surgical clamp to the jaws. [38] Surgical instrument according to claim 37, wherein the surgical clamp comprises a first and a second arm, and wherein the first and / or the second jaw comprises an engagement element for attaching the first and / or second arm of the clamp to said first and / or second jaw.

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